to capture margin status and chemotherapy regimens, but it seems to have little impact on this study. In addition, this study is the first large population-based study to investigate the role of adjuvant RT in pCCA. The potential selection bias in patients receiving adjuvant RT could be minimized by using propensity score matching. Although randomized evidence regarding adjuvant RT in resected pCCAs was absent, the result from this propensity score-matched analysis can provide insight into optimal treatment after curative intent surgery.
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Vaginal EBT was delivered using the Axxent EBT system. The EBT system consists of the X-ray source, the vaginal cylinder applicator, and the controller. The X-ray source comprises a miniaturized 50 kV X-ray tube in a multilumen catheter that allows cooling fluid to circulate over the tube. The vaginal cylinder applicators were designed to provide transmission characteristics specifically for the low energy X-rays emitted by the electronic X-ray source. The cylinders are composed of common medical-grade polymers, and have a 94% ± 5% X-ray transmission with respect to water. The X-ray tube is approximately 2.25 mm in diameter and 15 mm long, attached to a high-voltage cable, and encapsulated within an electrical ground. The controller provides power to the X-ray source and allows the X-ray source to be translated within the applicator. The translation or pullback movement of the X-ray source within the applicator is designed to provide a desired dose of radiation in the tissue surrounding the cylinder.
Surgical procedures for newly diagnosed patients varied according to the different clinical stages and primarily con- sisted of hysterectomy/subtotal hysterectomy ± excision of bilateral accessory ± pelvic lymphadenectomy. Some patients had been treated for uterine fibroids and underwent local resections at other hospitals. However, their pathologi- cal results were indicative of US, and thus they underwent another radical surgery. Use of AR was defined as external beam radiation to the pelvis (including the postoperative tumor bed, vaginal cuff, and the corresponding lymphatic drainage area). A dosage of 30–50 Gray was given 10–25 times, five times per week. The clinical and pathologic characteristics of the patients are summarized in Tables 1 and 2.
Adjuvant CHT represents another valid approach. Adjuvant carboplatin is the main option that has been explored over the years. The MRC TE19/EORTC trial was the first study that describes the use of carboplatin in adjuvant setting . Patients were randomized either RT either carboplatin single cycle. Update results confirmed the non inferiority of CHT versus RT in term of RFS at 5 years (94.7 % versus 96%, respectively) . However the trial was originally powered to exclude a 3% absolute relapse difference in any pair-wise comparison (30 Gy versus 20 Gy versus carboplatin); RFR absolute difference at 5 years was estimated 1.34% (90% CI, - 0.7% to 3.5%), thus the primary outcome measure was not completely achieved.
Consecutive adult patients diagnosed with GBM and re- ferred to The Department of Radiation Oncology at the Northern Sydney Cancer Centre are entered into a pro- spective database, approved by Institutional Ethics Re- view Board. 10 consecutive patients with GBM formally screened for a clinical study investigating an anti-angi- ogenesis agent over a two month period from February 2009 to March 2009 were included in this dosimetric study. These patients were part of a cohort of 100 conse- cutive patients with glioblastoma multiforme formally managed with adjuvant radiation therapy between 1st July 2007 and 31 st December 2011 under the dosimetric criteria and constraints specified as per the standard EORTC-NCI Protocol [1,6]. Patients proceeded to be managed with IMRT and IGRT utilising daily on-board imaging (OBI). For these 10 patients at an additional plan was produced using an optimal 3D conformal RT technique. The IMRT and 3DCRT plans were then util- ised for formal comparison.
Three randomized clinical trials have established the role of adjuvant radiation therapy. 1-3 SWOG 8794 revealed a survival advantage when patients who received adjuvant RT were compared to patients who were followed clinically with no salvage RT option even in the setting of PSA failure. 1 The other two trials – EORTC 22911 and ARO 96/02 – failed to reveal an overall survival advantage, likely due to the protocol stipulation of allowed or recommended salvage RT in men randomized to observation in case of biochemical failure. 2-3 Moreover, all three trials have shown a 10-year biochemical progression free survival rate of 26-41% in the observation arm, arguing that a third of patients with high risk features after radical
tumor size, comorbidity, margin and lymph node evaluation status, extent of lymph node resection, and the number of pos- itive nodes were included in analyses. Information on the type of surgery (wide excision or other), sites of radiation therapy (primary site and/or nodal), chemotherapy dose and regimen, and disease-specific mortality were not available. Increasing age, male sex, presence of comorbidities, positive margin status, and increasing tumor burden (reflected by the primary tumor size in stages I and II and the number of positive nodes in stage III) were associated with poorer survival across all stages. Surgery with adjuvant radiation therapy was associ- ated with statistically significant better overall survival than surgery alone on multivariate analysis for patients with stage I (n = 3,369) and stage II (n = 1,474) disease (p0.001). In con- trast, neither adjuvant radiation therapy nor chemotherapy was associated with statistically significant improvement or worsening survival in patients with stage III (n = 2,065) disease. Although the lack of benefit with adjuvant chemo- therapy was consistent with those reported in prior studies, the lack of benefit with radiation therapy for stage III dis- ease was surprising, given the improvement in locoregional control and survival seen in other studies. 12–14 The authors
This observational, nonrandomized, multicenter study was undertaken following FDA clearance of the EBT device in order to better understand the clinical use of EBT as an adjuvant radiation therapy for early stage breast cancer. Rep- resentatives from the ABS, the ASBS, and the ACRO guided protocol development, study conduct, and data analyses. The prospectively defined primary endpoints were device performance, skin and subcutaneous toxicities, efficacy out- comes, and cosmetic outcome. The present report includes 68 patients who have received treatment and have completed at least 1 month of follow-up. Six-month and 1-year follow-up data are available on 59 and 37 patients respectively.
versus 12 months with no radiation therapy and 17 months with adjuvant radiation therapy. In multivariate analysis, they found a significantly lower hazard ratio (HR) for death in patients receiving neoadjuvant radiation therapy rather than adjuvant radiation therapy (HR 0.63; 95% CI 0.45–0.90; P = 0.03) . In our study, the median overall survival was 19.0 months for those who received PORT versus 14.0 months for those who did not receive PORT between 1988 and 2012. The prognosis of pancreatic cancer is a very tough, though the survival rates have been improving particularly after 2007. The improvement may partially due to the early diagnosis and the development of treatment such as the introduction of gemcitabine as first-line treatment for patients with locally advanced adenocarcinoma of the pancreas. However, PORT remained as an independent good prognostic factor for pancreatic cancer patients with resection after adjusting for potential confounders such as year of diagnosis.
Methods: Patients with radiographically resectable, biopsy-proven pancreatic cancer were enrolled. Data were prospectively collected from 2012 to 2016. Cox proportional hazards regres- sion was used to identify factors predictive of survival. Propensity score matching analysis was performed to assess the efficacy of SBRT combined with different timing of chemotherapy. Results: One hundred patients were enrolled with 48 receiving induction chemotherapy and 52 undergoing adjuvant chemotherapy. The median overall survival (OS) and progression-free survival (PFS) were 17.5 months (95% CI: 15.8–19.2 months) and 13.7 months (95% CI: 12.3–15.1 months), respectively. Patients with adjuvant chemotherapy (P <0.001), CA19-9 response (P <0.001) and BED 10 (biological effective dose, α/β = 10) ≥ 60 Gy (P = 0.024) had a longer OS, while the former two correlated with PFS. Patients with more positive factors had a superior OS and PFS. After propensity score matching analysis, there were 23 patients from each group included in the analysis. Longer OS (23.1 months versus 15.6, P <0.001) and PFS (18.0 months versus 11.6 months, P <0.001) were found in patients with adjuvant chemotherapy compared with those with induction chemotherapy.
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Axillary treatment can eliminate residual disease in the ax- illa, decrease axillary recurrence and, perhaps, improve overall survival by improving local control. One breast can- cer death out of four local recurrences can be prevented over the 15 year period . ANC provides information on the number of positive nodes (extent of nodal involvement) and this may influence adjuvant systemic therapy and radiotherapy decisions.
 Q.Wu,M.Manning, R. Schmidt-Ullrich, and R. Mohan, ―The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: A treatment design study,‖ Int. J. Radiat. Oncol. Biol. Phys., vol. 46, pp. 195–205, Jan. 2000.
We reviewed all the experimental results of the curative ef- fect of interferon adjuvant treating patients with HCC. Computerized literature searches of PubMed, the Cochrane Library, and EMBASE database (2005–2015) were under- taken. Search words were “hepatocellular carcinoma,” “liver cancer,” “liver tumor,” “interferon.” Review was conducted with these terms separately in different combinations. In addition, references catalog of relevant original articles and comments were reviewed to find out other qualified trials.
No demographic factors (years in practice, geographic location of residency, geographic location of practice, month- ly patient volume, practice type) were found to correlate with treatment recommendation. When we analyzed for associa- tion with other treatment recommendations for men with prostate cancer, only recommendation of active surveillance for Gleason 3+4 disease was a significant predictor of recom- mending salvage RT following RP for disease with high-risk features (p=0.034) (Table 1). No other treatment recommen- dations (active surveillance recommendation for Gleason 6 disease, first choice treatment preference for low-risk prostate cancer, brachytherapy boost for high-risk disease, consider- ation of stereotactic body RT for oligometastatic disease, elec- tive pelvic lymph node coverage, support for incorporation of advanced imaging modalities in standard practice) were significant. Monthly patient volume approached significance for recommendation of adjuvant RT over salvage RT; respon- dents who see fewer than 15 patients per month were more likely to endorse adjuvant RT over salvage RT (p=0.062).
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After the treatment finished, patients were scheduled to visit for per vaginal examination (PV exam) in the follow-up program. The follow-up program schedule is every 3 months in the first 3 years after treatment, 6 monthly in years 4 and 5, then annually after five years. A vaginal examination was performed to evaluate the disease status according to World Health Organization (WHO) criteria . Investigations (tissue biopsy, medical imaging or laboratories) for disease progression were performed as indicated when patients presented with sug- gested symptoms. Late toxicities were evaluated according to the Radiation Therapy Oncology Group/European Organization of Research and Treatment of Cancer (RTOG/EORTC) late toxicity criteria .
tumor (WT), lymphomas and rhabdomyosarcoma (RMS). Seven patients received palliative radiation therapy (RT) and 123 received curative/adjuvant RT. Common sites of irradiation were cranium, head and neck, orbit and abdomen. The intended duration of treatment course ranged from 1-42 days. Twenty two patients required treatment interruption due to treatment related toxicity. Median duration of treatment interruption was 6 days.
Fourth, additional differences between study designs of the ASSURE and S-TRAC regarding sunitinib need to be considered. Foremost of these is the sample size difference that distinguishes ASSURE from S-TRAC. Specifically, the ASSURE trial randomized 647 patients to the sunitinib and placebo arms each. The S-TRAC trial was smaller with only 309 and 306 patients randomized to sunitinib or placebo, respectively. The sample size differences invariably weigh on the results of all meta-analyses. Indeed, the European Association of Urology (EAU) RCC guideline panel commented on a meta-analysis of the ASSURE and S-TRAC trials, to help reconcile the conflicting DFS data. The pooled ASSURE and S-TRAC derived DFS and OS estimates showed no differences favouring sunitinib over placebo: pooled DFS estimates resulted in a HR of 0.89 (95% CI: 0.67-1.19) and pooled OS estimates resulted in a HR of 1.12 (95% CI: 0.92-1.35). The meta-analysis exclusively focused on the sunitinib data of the ASSURE and on the central review for the S-TRAC trial. It is also important to note that the negative ASSURE trial had no central review. Conversely, the positive DFS findings were reported upon central review of the S-TRAC data. Similar to ASSURE, investigator review within the S-TRAC trial showed no statistically significant DFS benefit of adjuvant sunitinib, when all patients were analyzed (HR 0.81 95% CI 0.64-1.02), as well as when only patients with more aggressive characteristics were analyzed (HR 0.76 95% CI 0.58-1.01). This observation has two
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History of present illness (H/P/I) – patient was apparently alright one year back suddenly she got profuse white discharge PV, she consulted local gy- necologist. She was investigated for Pap smear. It revealed ca cervix. As it was early ca cervix she was advised local radiotherapy. After receiving radio- therapy for 30 days she was advised follow up. Six months after radiotherapy she suddenly started bleeding PR, frequency of motion. She was referred to superspeciality gastroenterology dept. of govt. medical college, Nagpur. On colonoscopic examina- tion she was diagnosed to have bleeding predomi- nant chronic radiation proctitis. She received prednisolon retention enema but she was unable to retain it & used to defecate just 10mins after giving enema. She got relief in frequency of motion but bleeding per rectum was continued.
an unmet need for a calf muscle exercise option for patients who may be receptive to exercise but may struggle with more strenuous walking or other exercises that involve standing for longer periods. This may be the case for patients who are elderly, frail, have limited mobility, have a fear of falling or are housebound. The present study offered a plantar resistance rocker pedal, called StepIt, to patients with VLUs in an adjuvant therapy to compression therapy. The aim of this prospective, randomised, controlled, feasibility study was to determine the acceptability and initial efficacy of the StepIt pedal with a primary clinical outcome measure of complete VLU healing.
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After providing written informed consent, patients were randomly assigned in a 1:1 ratio to receive standard adjuvant systemic therapy (control group) or standard adjuvant systemic therapy along with zoledronic acid. The zoledronic acid was admin- istered immediately after each cycle of adjuvant chemotherapy in a 4-mg dose by intravenous infu- sion every 3 to 4 weeks for 6 cycles and then every 3 months for 8 doses, followed by 5 cycles on a 6-month schedule for a total of 5 years. Dose ad- justments for renal-function abnormalities were recommended in accordance with the product li- cense. Daily oral supplements containing calcium (400 to 1000 mg) and vitamin D (200 to 500 IU) were recommended for all patients during the first 6 months and were continued thereafter at the dis- cretion of the treating physician.
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