Proton beam radiation has been used for cancer treatment since the 1950s, but recent increasing interest in this form of therapy and the construction of hospital-based and clinic-based facilities for ...its delivery have greatly increased both the number of patients and the variety of tumors being treated with proton therapy. The mass of proton particles and their unique physical properties (ie, the Bragg peak) allow proton therapy to spare normal tissues distal to the tumor target from incidental irradiation. Initial observations show that proton therapy is particularly useful for treating tumors in challenging locations close to nontarget critical structures. Specifically, improvements in local control outcomes for patients with chordoma, chonodrosarcoma, and tumors in the sinonasal regions have been reported in series using proton. Improved local control and survival outcomes for patients with cancer of the head and neck region have also been seen with the advent of improvements in better imaging and multimodality therapy comprising surgery, radiation therapy, and chemotherapy. However, aggressive local therapy in the proximity of critical normal structures to tumors in the head and neck region may produce debilitating early and late toxic effects. Great interest has been expressed in evaluating whether proton therapy can improve outcomes, especially early and late toxicity, when used in the treatment of head and neck malignancies. This review summarizes the progress made to date in addressing this question.
As the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate ...the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades.
The number of women as a percentage of the total surgeons per year were recorded for each year from 1969-2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables.
Data from the American Association of Medical Colleges (AAMC).
All full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records.
The percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001).
Representation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND:Despite the use of neoadjuvant chemoradiation and total mesorectal excision for rectal cancer, lateral pelvic lymph node recurrence is still an important problem.
OBJECTIVE:This study ...aimed to determine the indication for lateral pelvic lymph node dissection in post neoadjuvant chemoradiation rectal cancer.
DESIGN:This is a retrospective analysis of a prospectively collected institutional database.
SETTINGS:This study was conducted at a tertiary care cancer center from January 2006 through December 2017.
PATIENTS:Patients who had rectal cancer with suspected lateral pelvic lymph node metastasis, who underwent total mesorectal excision with lateral pelvic lymph node dissection, were included.
MAIN OUTCOME MEASURES:The primary outcome measured was pathologic lateral pelvic lymph node positivity.
INTERVENTIONS:The associations between lateral pelvic lymph node size on post-neoadjuvant chemoradiation imaging and pathologic lateral pelvic lymph node positivity and recurrence outcomes were evaluated.
RESULTS:A total of 64 patients were analyzed. The mean lateral pelvic lymph node size before and after neoadjuvant chemoradiation was 12.6 ± 9.5 mm and 8.5 ± 5.4 mm. The minimum size of positive lateral pelvic lymph node was 5 mm on post neoadjuvant chemoradiation imaging. Among 13 (20.3%) patients who had a <5 mm lateral pelvic lymph node after neoadjuvant chemoradiation, none were pathologically positive. Among 51 (79.7%) patients who had a ≥5 mm lateral pelvic lymph node after neoadjuvant chemoradiation, 33 patients (64.7%) were pathologically positive. Five-year overall survival and disease-specific survival were higher in the histologic lateral pelvic lymph node negative group than in the lateral pelvic lymph node positive group (overall survival 79.6% vs 61.8%, p = 0.122; disease-specific survival 84.5% vs 66.2%, p= 0.088). After a median 39 months of follow-up, there were no patients in the <5 mm group who died of cancer. There were no lateral compartment recurrences in the entire cohort.
LIMITATIONS:Being a single-center retrospective study may limit generalizability.
CONCLUSIONS:Post-neoadjuvant chemoradiation lateral pelvic lymph node size ≥5 mm was strongly associated with pathologic positivity. No patients with size <5 mm had pathologically positive lymph nodes. Following lateral pelvic lymph node dissection, no patients with a positive lateral pelvic lymph node developed lateral compartment recurrence. Therefore, patients who have rectal cancer with clinical evidence of lateral pelvic lymph node metastasis and post-neoadjuvant chemoradiation lateral pelvic lymph node size ≥5 mm should be considered for lateral pelvic lymph node dissection at the time of total mesorectal excision. See Video Abstract at http://links.lww.com/DCR/B3.
¿QUIéN DEBE RECIBIR LINFADENECTOMíA PéLVICA LATERAL DESPUéS DE LA QUIMIORRADIACIóN NEOADYUVANTE?A pesar del uso de quimiorradiación neoadyuvante y la escisión total de mesorectao para el cáncer de recto, la recurrencia en los ganglios linfáticos pélvicos laterales sigue siendo un problema importante.
OBJETIVO:Determinar la indicación para la disección de los ganglios linfáticos pélvicos laterales en el cáncer rectal post quimiorradiación neoadyuvante.
DISEÑO:Análisis retrospectivo de la base de datos institucional prospectivamente recopilada.
ESCENARIO:Centro de cáncer de atención terciaria, de enero de 2006 hasta diciembre de 2017.
PACIENTES:Pacientes con cáncer de recto con sospecha de metástasis en los ganglios linfáticos pélvicos laterales, que se sometieron a escisión total mesorectal con disección de los ganglios linfáticos pélvicos laterales.
PRINCIPALES MEDIDAS DE RESULTADOS:Positividad de ganglios linfáticos pélvicos laterales en histopatología.
INTERVENCIONES:Se evaluaron las asociaciones entre el tamaño de los ganglios linfáticos pélvicos laterales en imagenología postquimiorradiación neoadyuvante y la positividad y recurrencia en los ganglios linfáticos pélvicos laterales en histopatología.
RESULTADOS:Se analizaron un total de 64 pacientes. La media del tamaño de los ganglios linfáticos pélvicos laterales antes y después de la quimiorradiación neoadyuvante fue de 12.6 ± 9.5 mm y 8.5 ± 5.4 mm, respectivamente. El tamaño mínimo de los ganglios linfáticos pélvicos laterales positivos fue de 5 mm en las imágenes postquimiorradiación neoadyuvante. Entre 13 (20.3%) pacientes que tenían <5 mm de ganglio linfático lateral pélvico después de la quimiorradiación neoadyuvante; ninguno fue positivo en histopatología. Entre 51 (79.7%) pacientes con ganglio linfático pélvico lateral ≥ 5 mm después de la quimiorradiación neoadyuvante; 33 pacientes (64.7%) fueron positivos en histopatología. La supervivencia general a 5 años y la supervivencia específica de la enfermedad fueron mayores en el grupo histológico de ganglio linfático pélvico lateral negativo que en el grupo de ganglio linfático pélvico lateral positivo (Supervivencia general 79.6% vs 61.8%, p = 0.122; Supervivencia específica de la enfermedad 84.5% vs 66.2%, p = 0.088). Después de una mediana de seguimiento de 39 meses, no hubo pacientes en el grupo de <5 mm que hayan fallecido por cáncer. No hubo recurrencias en el compartimento lateral en toda la cohorte.
LIMITACIONES:Al ser un estudio retrospectivo en un solo centro puede limitar la generalización.
CONCLUSIONES:El tamaño de los ganglios linfáticos pélvicos laterales postquimiorradiación neoadyuvante ≥ 5 mm se asoció fuertemente con la positividad histopatológica. Ningún paciente con tamaño <5 mm tuvo ganglios linfáticos histopatológicamente positivos. Después de la disección de los ganglios linfáticos pélvicos laterales, ningún paciente con ganglios linfáticos pélvicos laterales positivos desarrolló recurrencia del compartimiento lateral. Por lo tanto, los pacientes con cáncer rectal con evidencia clínica de metástasis en los ganglios linfáticos pélvicos laterales y tamaño de ganglios linfáticos pélvicos laterales postquimiorradiación neoadyuvante ≥ 5 mm deben considerarse para disección de los ganglios linfáticos pélvicos laterales en el momento de la escisión total de mesorrecto. Vea el Abstract en video en http://links.lww.com/DCR/B3.
•Intensity modulated proton therapy (IMPT) is a sophisticated mode of proton therapy.•Dosimetric studies have demonstrated the superiority of IMPT over IMRT to improve dose sparing of organs in ...located in the head and neck.•There is clinical evidence that IMPT can translate to toxicity reductions for patients with HNCs.•This review will discuss existing literature and future directions of IMPT use for HNCs.
Radiation therapy plays an integral role in the management of head and neck cancers (HNCs). While most HNC patients have historically been treated with photon-based radiation techniques such as intensity modulated radiation therapy (IMRT), there is a growing awareness of the potential clinical benefits of proton therapy over IMRT in the definitive, postoperative and reirradiation settings given the unique physical properties of protons. Intensity modulated proton therapy (IMPT), also known as “pencil beam proton therapy,” is a sophisticated mode of proton therapy that is analogous to IMRT and an active area of investigation in cancer care. Multifield optimization IMPT allows for high quality plans that can target superficially located HNCs as well as large neck volumes while significantly reducing integral doses. Several dosimetric studies have demonstrated the superiority of IMPT over IMRT to improve dose sparing of nearby organs such as the larynx, salivary glands, and esophagus. Evidence of the clinical translation of these dosimetric advantages has been demonstrated with documented toxicity reductions (such as decreased feeding tube dependency) after IMPT for patients with HNCs. While there are relative challenges to IMPT planning that exist today such as particle range uncertainties and high sensitivity to anatomical changes, ongoing investigations in image-guidance techniques and robust optimization methods are promising. A systematic approach towards utilizing IMPT and additional prospective studies are necessary in order to more accurately estimate the clinical benefit of IMPT over IMRT and passive proton therapy on a case-by-case basis for patients with sub-site specific HNCs.
PURPOSEThis study aimed to analyze gender differences in rank, career duration, publication productivity, and research funding among radiation oncologists at U.S. academic institutions.
METHODFor 82 ...domestic academic radiation oncology departments, the authors identified current faculty and recorded their academic rank, degree, and gender. The authors recorded bibliographic metrics for physician faculty from a commercially available database (Scopus, Elsevier BV), including numbers of publications from 1996 to 2012 and h-indices. The authors then concatenated these data with National Institutes of Health (NIH) funding per Research Portfolio Online Reporting Tools. The authors performed descriptive and correlative analyses, stratifying by gender and rank.
RESULTSOf 1,031 faculty, 293 (28%) women and 738 (72%) men, men had a higher median m-index, 0.58 (range 0–3.23) versus 0.47 (0–2.5) (P < .05); h-index, 8 (0–59) versus 5 (0–39) (P < .05); and publication number, 26 (0–591) versus 13 (0–306) (P < .05). Men were more likely to be senior faculty and receive NIH funding. After stratifying for rank, these differences were largely nonsignificant. On multivariate analysis, there were correlations between gender, career duration and academic position, and h-index (P < .01).
CONCLUSIONSDeterminants of a successful career in academic medicine are multifactorial. Data from radiation oncologists show a systematic gender association, with fewer women achieving senior faculty rank. However, women achieving seniority have productivity metrics comparable to those of male counterparts. This suggests that early career development and mentorship of female faculty may narrow productivity disparities.
BACKGROUND:Many factors play a role in academic promotion among orthopaedic surgeons. This study specifically examined the importance of publication productivity metrics, career duration, and sex on ...academic rank in orthopaedic surgery programs in the United States.
METHODS:Faculty at 142 civilian academic orthopaedic surgery departments in 2014 were identified. Geographic region, department size, and 3 specific faculty characteristics (sex, career duration, and academic position) were recorded. The Hirsch index (h-index), defined as the number (h) of an investigator’s publications that have been cited at least h times, was recorded for each surgeon. The m-index was also calculated by dividing the h-index by career duration in years. Thresholds for the h-index and the m-index were identified between junior and senior academic ranks. Multivariate analysis was used to determine whether the 3 physician factors correlated independently with academic rank.
RESULTS:The analysis included 4,663 orthopaedic surgeons at 142 academic institutions (24.7% clinical faculty and 75.3% academic faculty). Among academic faculty, the median h-index was 5, the median career duration was 15 years, and the median m-index was 0.37. Thresholds between junior and senior faculty status were 12 for the h-index and 0.51 for the m-index. Female academic faculty had a lower median h-index (3 compared with 5; p < 0.001) and career duration (10 years compared with 16 years; p < 0.001) than male academic faculty, but had a similar median m-index (0.33 compared with 0.38; p = 0.103). A higher h-index and longer career duration correlated independently with an increased probability of senior academic rank (p < 0.001), but sex did not (p = 0.217).
CONCLUSIONS:This analysis demonstrates that a higher h-index and m-index correlate with a higher academic orthopaedic faculty rank. Although female surgeons had a lower median h-index and a shorter median career duration than male surgeons, their m-index was not significantly different, and thus sex was not an independent predictor for senior academic rank. The identified thresholds (h-index of 12 and m-index of 0.51) between junior and senior academic ranks may be considered as factors in promotion considerations.
PURPOSEFemale representation in academic medicine is increasing without proportional increases in female representation at senior ranks. The purpose of this study is to describe the gender ...representation in academic gastroenterology (GI) and compare publication productivity, academic rank, and career duration between male and female gastroenterologists.
METHODIn 2014, the authors collected data including number of publications, career duration, h-index, and m-index for faculty members at 114 U.S. academic GI programs.
RESULTSOf 2,440 academic faculty, 1,859 (76%) were men and 581 (24%) were women. Half (50%) of men held senior faculty position compared with 29% of women (P < .001). Compared with female faculty, male faculty had significantly (P < .001) longer careers (20 vs. 11 years), more publications (median 24 0–949 vs. 9 0–438), and higher h-indices (8 vs. 4). Higher h-index correlated with higher academic rank (P < .001). The authors detected no difference in the h-index between men and women at the same rank for professor, associate professor, and instructor, nor any difference in the m-index between men and women (0.5 vs. 0.46, respectively, P = .214).
CONCLUSIONSA gender gap exists in the number and proportion of women in academic GI; however, after correcting for career duration, productivity measures that consider quantity and impact are similar for male and female faculty. Women holding senior faculty positions are equally productive as their male counterparts. Early and continued career mentorship will likely lead to continued increases in the rise of women in academic rank.
There are unique challenges to parenting in residency and there is limited data to guide policy regarding lactation facilities and support for female physicians-in-training. We aimed to assess issues ...surrounding breast-feeding during graduate medical training for current residents or recent graduates from United States (US) residency programs.
A national cross-sectional survey was sent to current and recently graduated (2017 and later) female residents in June 2020. This questionnaire was administered using the Qualtrics Survey tool and was open to each participating woman's organization for 4 weeks. Summary statistics were used to describe characteristics of all respondents and free-text responses were reviewed to identify common themes regarding avenues for improvement.
Three hundred twelve women responded to the survey, representing a 15.6% response rate. The median duration of providing breastmilk was 9 months (IQR 6-12). 21% of residents reported access to usable lactation rooms within their training hospital, in which 12% reported a computer was present. 60% of lactating residents reported not having a place to store breast milk. 73% reported residency limited their ability to lactate, and 37% stopped prior to their desired goal. 40% reported their faculty and/or co-residents made them feel guilty for their decision to breastfeed, and 56% reported their difficulties with breastfeeding during residency impacted their mental health.
Residents who become mothers during training face significant obstacles to meeting their breastfeeding/pumping needs and goals. With these barriers defined, informed policy change can be instituted to improve the lactation experience for physicians-in-training.
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