High-grade glioma management and response assessment-recent advances and current challenges.

The management of high-grade gliomas (hggs) is complex and ever-evolving. The standard of care for the treatment of hggs consists of surgery, chemotherapy, and radiotherapy. However, treatment options are influenced by multiple factors such as patient age and performance status, extent of tumour resection, biomarker profile, and tumour histology and grade. Follow-up cranial magnetic resonance imaging (mri) to differentiate treatment response from treatment effect can be challenging and affects clinical decision-making. An assortment of advanced radiologic techniques-including perfusion imaging with dynamic susceptibility contrast mri, dynamic contrast-enhanced mri, diffusion-weighted imaging, proton spectroscopy, mri subtraction imaging, and amino acid radiotracer imaging-can now incorporate novel physiologic data, providing new methods to help characterize tumour progression, pseudoprogression, and pseudoresponse. In the present review, we provide an overview of current treatment options for hgg and summarize recent advances and challenges in imaging technology.

Increased risk of second malignancies in chronic lymphocytic leukaemia patients as compared with follicular lymphoma patients: a Canadian population-based study.

BACKGROUND: Chronic lymphocytic leukaemia (CLL) patients have an increased risk of other malignancies. This may be due to surveillance bias, treatment or immunosuppression. METHODS: Cohort study of 612 consecutively diagnosed CLL patients in a Canadian province, with comparisons to follicular lymphoma (FL) patients. RESULTS: Treated CLL patients had a 1.7-fold increased risk of second cancers compared with untreated CLL patients. As compared with untreated FL patients, untreated CLL patients had a two-fold increased incidence of second malignancies. CONCLUSION: Chronic lymphocytic leukaemia patients have an inherent predisposition to second cancers and the incidence is further increased by treatment.

Antiestrogen use and survival of women with non-small cell lung cancer in Manitoba, Canada.

Lung cancer is the leading cause of cancer death worldwide. Sex differences in lung cancer incidence and survival are known. Female sex is an independent good prognostic factor. Estrogens appear to play a key role in lung cancer outcomes. Accordingly, antiestrogen use may also influence survival in female non-small cell lung cancer (NSCLC) patients. In this study, we compared survival among antiestrogen users and nonusers. We performed a retrospective population-based study. Using the Manitoba Cancer Registry (MCR), we identified all women diagnosed with NSCLC from 2000 to 2007. The population-based Drug Program Information Network was accessed to establish which patients received antiestrogens. Demographic data (e.g., smoking patterns, stage, histology) were gathered from the MCR and by chart review. Survival differences between antiestrogen-exposed and not exposed groups were compared using multivariable Cox regression. Two thousand three hundred twenty women fit our patient criteria, of which 156 had received antiestrogens. Exposure to antiestrogens was associated with a significantly decreased mortality in those exposed both before and after the diagnosis of NSCLC (adjusted hazard ratio, 0.42, p = 0.0006). This association remained consistent across age and stage groups. Antiestrogen use before and after the diagnosis of NSCLC is associated with decreased mortality. This supports previous evidence that estrogens may play a key role in the biology and outcomes of NSCLC and suggests a potential therapeutic use for these agents in this disease.

Extended adjuvant temozolomide with cis-retinoic acid for adult glioblastoma.

OBJECTIVE: To determine the toxicity and effectiveness of 24 months of adjuvant temozolomide (tmz) with cis-retinoic acid (cra) for patients with glioblastoma. METHODS: This retrospective population-based review considered the charts of all patients diagnosed with glioblastoma in Manitoba and referred to a provincial cancer centre during 2002-2008. Consecutive patients came from a population-based referral centre and provincial cancer registry. All patients were treated according to the local standard of care with surgical resection followed by concurrent radiotherapy and tmz 75 mg/m(2) daily, followed by tmz 150-200 mg/m(2) for days 1-5, repeated every 28 days for up to 24 cycles, and cra 50 mg/m(2) twice daily for days 1-21, repeated every 28 days. The main outcome measures were safety, tolerability, and effectiveness of long-term tmz and cra. RESULTS: Of 247 patients diagnosed with glioblastoma in Manitoba during the study period, 116 started concurrent chemoradiotherapy, and 80 received adjuvant tmz. Of the patients who started concurrent chemoradiotherapy, 80 began adjuvant chemotherapy. Patients completed a median of 5.5 cycles of tmz and 3 cycles of cra. Grade 3 or 4 hematologic toxicity was noted in 16% of patients. Median overall survival was 15.1 months, and 26.7% of patients remained alive at 2 years. CONCLUSIONS: Extended adjuvant tmz and cra is well tolerated. However, the population-based effectiveness of this regimen is similar to the clinical trial efficacy of 6 months of adjuvant tmz. Future studies in glioblastoma should incorporate duration of adjuvant chemotherapy into the study design.

Wait times from presentation to treatment for colorectal cancer: a population-based study.

BACKGROUND: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada. OBJECTIVE: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC). METHODS: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living's administrative databases, a patient's first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT. RESULTS: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT. CONCLUSIONS: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.

High incidence of chronic lymphocytic leukemia (CLL) diagnosed by immunophenotyping: a population-based Canadian cohort.

Incidence and outcomes of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) are not well established at the population level, especially since the widespread use of immunophenotyping. We studied the epidemiology of CLL in Manitoba (Canada) by combining data from a centralized flow cytometry facility and the provincial cancer registry for the period 1998-2003. Of 616 cases identified, 27% of patients identified by flow cytometry were not on the cancer registry. The age-adjusted incidence of 7.99/100,000 is substantially higher than the reported incidence in registry reports. We also noted differences in relative survival based on age and gender.

Myeloid sarcoma of the uterus presenting as vaginal bleeding.

Extramedullary relapse of acute myeloid leukaemia may occur in sites such as the central nervous system, testes, and skin. Presentations in the female genital tract are uncommon and usually asymptomatic. In contrast, symptomatic uterine myeloid sarcoma is very rare. Treatment of this is generally unsuccessful, but is improved when systemic therapies are used. We study a case of a uterine relapse of acute myeloid leukaemia presenting as vaginal bleeding and successfully managed by local irradiation. The mechanism of preferential infiltration of uterine tissue requires further study.

Evaluation of a sampling strategy for estimation of long-term PM2.5 exposure for epidemiological studies.

As part of the European Community Respiratory Health Survey (ECRHS) PM2.5 (particles collected with an upper 50% cut point of 2.5 microm aerodynamic diameter) was measured using an EPA-WINS (Environmental Protection Agency Well Impactor Ninety-six) sampler. The monitoring schedule was restricted to 7 days per month for one year. Simultaneously, during this one year study period a collocated Harvard Impactor (HI) was run on a daily basis in Erfurt, Germany. Here we validated the reliability of annual, seasonal and monthly means estimated using the ECRHS scheme (measurements taken less than 25% of the whole study period) with the 'true' long-term averages, which were estimated using all available daily means. The daily PM2.5 means, obtained by both instruments operated in parallel, were only slightly different (the mean difference between EPA-WINS and HI was 1.8 microg m(-3) and 2.8 microg m(-3) for the winter means). The values obtained by the two instruments were highly correlated (r = 0.95). In view of that negligible difference, no additional bias was seen with respect to the annual and the winter means estimated by the two different sampling strategies (the difference was 1.7 microg m(-3) and 2.7 microg m(-3), respectively). Monthly means, however, can only be considered to be a crude estimate that may substantially under- or overestimate the true monthly mean value.

[Environmental surveys in the areas of Bitterfeld, Hettstedt and a comparative area in 1992-2000]. / Umweltmedizinische Untersuchungen im Raum Bitterfeld, im Raum Hettstedt und in einem Vergleichsgebiet 1992-2000.

The aim of the environmental epidemiological study was to determine possible adverse effects on the health of children in the environmentally polluted areas of Bitterfeld and Hettstedt compared to the less polluted area of Zerbst (Eastern Germany). The changes of the health parameters were recorded together with the environmental changes during the time period of 6 years. The study design consisted of three repeated regional cross-sectional studies in 1992/93, 1995/96 and 1998/99. In total, 7,611 questionnaires could be analysed (participation rate: 89%, 75% and 75%). Children living in the most polluted area of Hettstedt had a noticeable higher risk for non-allergic respiratory diseases and symptoms compared to children living in the control area of Zerbst. From 1992 to 1999 a statistically significant decrease in the prevalences of these health outcomes was found. Children without indoor pollutants in their homes had the greatest benefit by the improvement of ambient air quality. The increase in lung function (FVC, FEV1) also underlines the improvement of the respiratory health. Children living in the polluted areas reported allergies more often (physician's diagnosis, allergy specific antibodies). The prevalence of asthma, the bronchial hyperreactivity and atopic eczema was increased within the observational period of 6 years. An increased prevalence was also shown for more severe allergic sensitisation (RAST classes > 17.5 kU/l), while the prevalence of hay fever increased slightly on a non-significant level. The burden with lead and cadmium was higher in children living in polluted areas and decreased during the study period except for 1997 where the lead concentration in blood increased according to the higher lead concentration in settled dust in Hettstedt at that time.

[Nursing care planning--that also! Presentation at the 50th Scientific Session of the Society of Pediatric Oncology and Hematology within the scope of the of the KOK AND PSAPOH general session]. / Pflegeplanung--auch das noch! Vortrag anlässlich der 50. Wissenschaftlichen Sitzung der Gesellschaft für Pädiatrische Onkologie und Hämatologie im Rahmen der Gemeinsamen Sitzung von KOK und PSAPOH.

The relevance of structured planning and documentation in caring for chronically ill patients within the framework of a holistic nursing approach is emphasized. The author's claims are based on his experience in such kind of structured approach during two years of practicing as a paediatric nurse in the paediatric hospital of Hamburg/Eppendorf where such planning and documentation are encouraged and accompanied by supervisory support. The focus lies on the realisation of planning and documentation in nursing on the ward, on the requirements in terms of co-operation, and the consequences in terms of positive effects on a holistic approach towards patient care.