Moving toward uniform and evidence-based practice of radiotherapy for management of cervical cancer in Ontario, Canada.

PURPOSE: To recognize the practice of radiotherapy for management of cervical cancer in Ontario, Canada, and to use the results of the survey to harmonize and standardize practice across the province. METHODS AND MATERIALS: An electronic survey (SurveyMonkey) was sent to all 14 provincial cancer centers by Cancer Care Ontario Gynecology Community of Practice (CoP) in 2013. The survey included 72 questions in four different categories: general/demographic, pretreatment assessment, external beam radiotherapy (EBRT), and brachytherapy (BT). RESULTS: Ten of 14 centers treated cervical cancer patients and had a dedicated BT suite. All 10 centers had a peer review process for quality assurance. EBRT technique was a 4-field box in eight of 10 centers. The dose/fractionation for pelvic EBRT was 45-50 Gy in 1.8-2 Gy/fraction in all but one center. Nine of 10 centers used high-dose-rate BT. Only one center offered interstitial BT. For treatment planning, two centers used CT and MRI, five centers used CT, and three centers used orthogonal x-rays. Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology guidelines were used in four of seven of the centers for target volume delineation and in five of seven centers for organs at risk dose constraints. All but one center prescribed and reported dose to Point A. CONCLUSIONS: The survey identified areas where practice varied across the province. Gynecology CoP used this information to identify priorities for practice change and implemented several strategies to harmonize the care of women with cervical cancer. This highlights the value of interdisciplinary, grass-roots initiatives such as CoPs to standardize practice in a practical manner that directly benefits patients.

Treatment of infected pseudoaneurysm in drug abusers: ligation or reconstruction?

BACKGROUND: Recently, there has been an increase in the incidence of major vascular complications such as infected pseudoaneurysm due to intravenous drug use. OBJECTIVE: For better understanding of the existing controversies regarding the optimal surgical management of infected pseudoaneurysm, the present study was conducted. METHODS: Medical charts of 36 consecutive patients who underwent surgery in Taleghani Hospital, Tehran, Iran from 1996 through 2003, were retrospectively analyzed. RESULTS: We studied the hospital records of 33 cases; two patients had bilaterally infected pseudoaneurysms and one underwent an emergency reoperation. The total number of operations was 36. Eleven cases (30.5%) underwent ileofemoral reconstruction and 25 (69.5%) arteries were ligated. All patients presented with infected femoral or brachial pseudoaneurysms due to intravenous drug abuse. Postoperatively, there was no hemorrhage, vascular thrombosis, amputation, or mortality. Three cases (8%) had incisional infections (2 [18%] after reconstruction and 1 [4%] after ligation operation) and 7 patients (19%) had claudication (all after ligation). CONCLUSION: Ligation is the optimal management for infected pseudoaneurysm, because it is easy, cost-effective, and safe. Reconstruction is not recommended, because of an extended infection at the location of pseudoaneurysm and at the artificial graft site.