RESUMO
BACKGROUND: Neoadjuvant treatment modalities in soft tissue sarcoma (STS) of the extremities have become more popular in recent years, but because of the rarity and heterogeneity of STS, there are yet few studies on the long-term impact of neoadjuvant treatment modalities, especially in terms of neoadjuvant radiochemotherapy. METHODS: The study enrolled 136 patients with primary STS of the extremities who underwent surgery with curative intent or neoadjuvant therapy, followed by surgery in a 15-year period. Neoadjuvant treatment consisted of radiotherapy (RT) with 60 Gy and in most cases simultaneous chemotherapy (CTx) with ifosfamide (1.5 g/m2/d, d1-5, q28) and doxorubicine (50 mg/m2/d, d3, q28). We investigated the clinical, (post)-operative and histopathological data and the oncological follow-up as well. The median follow-up period was 82 months (range 6-202). RESULTS: A total of 136 patients (M:F = 73:63) with a mean age of 62 years (range; 21-93) was observed. Seventy-four patients (54.4%) received neoadjuvant therapy (NT), 62 patients (45.6%) received primary surgery (PS). When receiving NT, patients with high-risk STS had a lower risk to develop distant metastasis (p = 0.025). Age, histological type, tumor size and surgical margins (R0 vs. R1) had no influence on any survival rates. There was an association between NT and the occurrence of postoperative complications (p = 0.001). The 5-year local recurrence free survival (LRFS), metastasis free survival (MFS), disease free survival (DFS) and overall survival (OS) rate of the whole cohort was 89.9%, 77.0%, 70.6% and 72.6%; whereas the 5-year LRFS, MFS, DFS and OS rate was 90.5%, 67.2%, 64.1% and 62.8% for the NT group and 89.5%, 88.3%. 78.4% and 83.8% for the PS group. CONCLUSIONS: Multimodal treatment strategies in patients with STS of extremities lead to excellent oncological outcomes. Patients with high-risk STS had a significantly better MFS when receiving NT than patients with low-risk STS. NT was associated with a higher probability of postoperative but well-manageable complications.
RESUMO
Background: Implementing e-learning into medical education is a growing field of research. Researchers have had positive experiences so far, and evidence suggests it to be no less effective than offline teaching. However, there are a few findings concerning psychiatric education and the use of simulated patients online. Methods: We developed an online workshop for medical students at our psychiatric clinic, including group work exercises, lectures, and interviews with simulated patients. To compare the learning outcome, a cohort of students learning online was compared with a previous cohort that learned on-site. The same objective structured clinical examination (OSCE) was used in both cases. Evaluation questionnaires were gathered from students and lecturers and were compared with the former semesters along with the exam results. Results: The exam grades did not significantly differ between on-site and online teaching, even though students rated their own communication skills better with online teaching. We also found that the connection experienced between students and teachers was impaired without on-site contact. Discussion: We conclude that an online course may be an effective alternative to on-site teaching but requires further improvement to maintain a dependable student-teacher relationship.
