Self-expandable metallic covered stents (SEMS) are widely used for the palliation of esophageal cancer. In the long term, a drawback of these stents is the occurrence of nontumoral occlusion at their ...proximal or distal parts. New self-expanding plastic stents (SEPS) may combine the advantages of SEMS with those of previously used plastic stents. Our aim was to study prospectively the implantation of such stents in a series of patients with fairly long life expectancy, focusing on safety, feasibility and long-term effectiveness.
Between June 1999 and December 2000, in a prospective cohort study, 33 patients were treated with Polyflex stents for palliation of esophageal stenoses, and were followed up until death. The inclusion criteria demanded the presence of a nonresectable or nonoperable, histologically proven, malignant stricture of the esophagus causing significant dysphagia.
Stent insertion was successful in all cases. The mean duration of follow-up of the patients was 149.7 days (range 25 - 469). A complete follow-up until death was documented for all patients (n = 33). During the entire follow-up, no stent occlusion was observed which was caused by either nontumoral or tumoral ingrowth, or by nontumoral overgrowth. Stent occlusions were caused only by tumoral overgrowth, and occurred at a rate of 12.1 % (n = 4). The stent migration rate was 6.0 % (n = 2), and the re-intervention rate overall was 21.1 % (n = 7).
These results show that SEPS are effective for the palliation of dysphagia in patients with esophageal malignancies. The immediate results are similar to those observed with SEMS, and the observed low rate of late obstruction suggests that their long-term efficacy might be superior to that of SEMS. This device warrants evaluation in a controlled prospective trial.
Objective. The aim of this study was to determine the feasibility and toxicity of concomitant vinorelbine, paclitaxel, and pelvic radiation therapy (RT) in patients with advanced cervical cancer and ...other pelvic malignancies.
Methods. Eligible patients included those with large or locally advanced cervical cancer. In addition, patients with other advanced gynecologic malignancies were eligible. In part I, vinorelbine was administered as a single agent during pelvic RT at a starting dose of 10 mg/m2/week with subsequent cohorts being escalated in 5 mg/m2/week increments. In part II, paclitaxel was added to vinorelbine (20 mg/m2/week) and pelvic RT at a starting dose of 20 mg/m2/week.
Results. Thirty-three women with pelvic malignancies (22 cervix, 6 vagina, 3 endometrium, 2 vulva) were enrolled. Twenty-seven received vinorelbine and 6 received both paclitaxel and vinorelbine in combination with pelvic RT. Escalating vinorelbine doses to 25 mg/m2/week were well tolerated, with the primary toxicity being hematologic. RT was delayed in only 1 patient due to acute hematologic toxicity. In contrast, the combination of paclitaxel, vinorelbine, and pelvic RT was not well tolerated. Five of 6 patients (83%) experienced grade ≥2 leukopenia, with 2 patients missing >1 cycle of chemotherapy. Moreover, RT was delayed for 1 week in 2 of 6 patients (33%).
Conclusions. Concomitant pelvic RT and vinorelbine with doses to 25 mg/m2/week is well tolerated. The addition of paclitaxel to this combination is associated with significant hematologic toxicity and is thus not a feasible approach.
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Accreditation based on peer review of professional standards of care is essential in ensuring quality and safety in administration of radiation therapy. Traditionally, medical chart reviews have been ...performed by a physical onsite visit. The American College of Radiation Oncology Accreditation Program has remodeled its process whereby electronic charts are reviewed remotely.
Twenty-eight radiation oncology practices undergoing accreditation had three charts per practice undergo both onsite and online review. Onsite review was performed by a single reviewer for each practice. Online review consisted of one or more disease site-specific reviewers for each practice. Onsite and online reviews were blinded and scored on a 100-point scale on the basis of 20 categories. A score of less than 75 was failing, and a score of 75 to 79 was marginal. Any failed charts underwent rereview by a disease site team leader.
Eighty-four charts underwent both onsite and online review. The mean scores were 86.0 and 86.9 points for charts reviewed onsite and online, respectively. Comparison of onsite and online reviews revealed no statistical difference in chart scores ( P = .43). Of charts reviewed, 21% had a marginal (n = 8) or failing (n = 10) score. There was no difference in failing charts ( P = .48) or combined marginal and failing charts ( P = .13) comparing onsite and online reviews.
The American College of Radiation Oncology accreditation process of online chart review results in comparable review scores and rate of failing scores compared with traditional on-site review. However, the modern online process holds less potential for bias by using multiple reviewers per practice and allows for greater oversight via disease site team leader rereview.
In several areas of Spain, the greenhouse whitefly, Trialeurodes vaporariorum (Westwood), and the sweet potato whitefly, Bemisia tabaci (Gennadius), coexist in tomato, Lycopersicon esculentum Miller. ...For integrated pest management decision-making, it is important to know the abundance of each species, because they exhibit different abilities to transmit viruses, are susceptible to different biological control agents, and have different responses to insecticides. This study was conducted to provide information on the vertical distribution of T. vaporariorum and B. tabaci in tomato plants grown in greenhouses in winter and to determine the optimal sampling unit and the sample size for estimating egg and nymphal densities of both whitefly species. Eggs of T. vaporariorum were mainly located on the top stratum of the plant, whereas B. tabaci eggs were mainly found on the middle stratum. Nymphs of both species mainly concentrated in the bottom stratum of the plant. When pest abundance and low relative variation were considered, the bottom stratum was selected as the most convenient for sampling nymphs of both whitefly species. Conversely, the same two criteria indicated that either the top or the middle strata could be used when sampling T. vaporariorum and B. tabaci eggs. Several different sampling units were compared to optimize the estimation of nymphal and egg densities in terms of cost efficiency. One disk (1.15 cm in diameter) per leaflet collected from the top stratum of the tomato plant was the most efficient sampling unit for simultaneously estimating the egg densities of the two whitefly species.
Cet entretien, réalisé à l'occasion de la parution du dernier ouvrage d'Arno J. Mayer, Les Furies, permet de retracer l'itinéraire intellectuel de cet historien du contemporain nourri de science ...politique et d'un marxisme hétérodoxe. Il met en lumière tout l'intérêt des méthodes et des questionnements d'un chercheur soucieux de penser de manière comparée les moments de crise sociale et politique en Europe et d'en comprendre la violence. Les prises de position politiques d'A. J. Mayer éclairent son œuvre et dessinent les difficultés et les originalités d'un parcours engagé dans l'université américaine depuis la fin des années 1950. This interview, conducted on the occasion of the publication of Arno J. Mayer's latest book, Les Furies, recounts the intellectual itinerary of this historian of the contemporary period, nurtured by political science and unorthodox Marxism. It brings out the interesting aspects of the methods and questioning used by this researcher who studies moments of social and political crisis in Europe comparatively and aims at understanding their violence. The political positions taken by A. J. Mayer help explain his writings and indicate the problems and originality of the path taken by a committed scholar who has been working in American universities since the end of the 1950s.
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