Is it safe to omit radiotherapy following wide local excision for ductal carcinoma in situ?

BACKGROUND: Debate regarding the use of radiotherapy (RT) after breast conserving surgery is currently one of the most controversial areas in breast cancer management. In our centre we prefer to avoid RT, which is not without its own risks, as a primary treatment modality in the majority of cases of ductal carcinoma in situ (DCIS) that are amenable to wide local excision. METHODOLOGY: Prospectively entered data were reviewed for all patients (n=100) that underwent breast conserving surgery for DCIS by the senior author over a ten year period. Kaplan-Meier survival curves were calculated for the total sample and for a series of univariate analyses. RESULTS: The mean follow-up for this sample was 50 months. The overall rate of recurrence was 6%, one-third of which were invasive. The estimated eight year disease free survival was 91.6%. CONCLUSIONS: In this group of patients outcome has not been affected by radiation therapy, hormone manipulation or chemotherapy. It has therefore enabled us to assess recurrence rates free of any potentially confounding treatment related influences. The results from this study suggest, that in our hands, the recurrence rates for DCIS following wide local excision alone are similar to those reported in series in which radiotherapy was used as adjuvant treatment.

The epidemiology and mortality of pretibial lacerations.

Pretibial lacerations are common injuries which have an underestimated mortality associated with their occurrence, and an under-appreciated morbidity associated with their treatment - they account for 5.2 out of every 1000 Emergency Department attendances in the United Kingdom, and occur mostly in the elderly. They are also increasingly being referred to plastic surgery units - the authors' department saw an increase from 58 referrals in twelve months in 2005/2006 to 113 referrals in six months in 2011. The Queen Victoria Hospital, East Grinstead, follows an evidence based and multi-disciplinary practice for the treatment of these injuries. The authors present the outcomes of patients referred to the hospital from the community and treated according to these guidelines, and compares the outcomes and mortality to a period prior to the introduction of this practise. The average time for skin grafted wounds to heal is found to be 59.8 days and for the donors it is 50.3 days, compared with an average time to healing of 123 days for those managed conservatively. The one month and one year mortality associated with these injuries is highlighted, as is the reduction in these figures following the adherence to the current treatment regime - prior to its introduction the 31 day mortality was 15%, and this was reduced to 4.3% by achievable changes in practice and treatment. Finally, the relevant extant research literature regarding pretibial lacerations is reviewed.

Medium-term outcomes of pyrocarbon arthroplasty of the proximal interphalangeal joint.

We evaluated the outcome of pyrocarbon arthroplasty for proximal interphalangeal joint osteoarthritis in 18 arthroplasties carried out by a single surgeon using the Ascension prosthesis (Ascension Orthopedics Inc., Austin, Texas) in 15 patients after a mean of 6.2 years. Significant and maintained improvements in pain scores at rest and on active movements were achieved for surviving implants, and the range of motion was comparable with preoperative measurements. The radiographs, which were evaluated for evidence of ongoing migration and potential failure, were of concern in 10 out of 18 joints. Two patients required implant removal.