Previous analysis of this Intergroup trial demonstrated that with a median follow-up among surviving patients of 45.9 months, the concurrent postoperative administration of cisplatin and radiation ...therapy improved local-regional control and disease-free survival of patients who had high-risk resectable head-and-neck carcinomas. With a minimum of 10 years of follow-up potentially now available for all patients, these results are updated here to examine long-term outcomes.
A total of 410 analyzable patients who had high-risk resected head-and-neck cancers were prospectively randomized to receive either radiation therapy (RT: 60 Gy in 6 weeks) or identical RT plus cisplatin, 100 mg/m(2)i.v. on days 1, 22, and 43 (RT + CT).
At 10 years, the local-regional failure rates were 28.8% vs 22.3% (P=.10), disease-free survival was 19.1% vs 20.1% (P=.25), and overall survival was 27.0% vs 29.1% (P=.31) for patients treated by RT vs RT + CT, respectively. In the unplanned subset analysis limited to patients who had microscopically involved resection margins and/or extracapsular spread of disease, local-regional failure occurred in 33.1% vs 21.0% (P=.02), disease-free survival was 12.3% vs 18.4% (P=.05), and overall survival was 19.6% vs 27.1% (P=.07), respectively.
At a median follow-up of 9.4 years for surviving patients, no significant differences in outcome were observed in the analysis of all randomized eligible patients. However, analysis of the subgroup of patients who had either microscopically involved resection margins and/or extracapsular spread of disease showed improved local-regional control and disease-free survival with concurrent administration of chemotherapy. The remaining subgroup of patients who were enrolled only because they had tumor in 2 or more lymph nodes did not benefit from the addition of CT to RT.
Background
Advances in medical knowledge have contributed to the increase in the number of children living with some form of long‐term chronic illness or condition. As a consequence of these ...advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of parent work, the challenges experienced, and the flow‐on consequences to well‐being.
Methods
Employing a narrative, meta‐synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness.
Results
The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of “doing it all.” And third, the above challenges lead to additional impacts on parental quality of life.
Conclusions
This review summarizes what is currently known about work patterns, challenges, and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched, other challenges (eg, personal and family) and impacts on their well‐being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings.
DARk matter WImp search with liquid xenoN (DARWIN) will be an experiment for the direct detection of dark matter using a multi-ton liquid xenon time projection chamber at its core. Its primary goal ...will be to explore the experimentally accessible parameter space for Weakly Interacting Massive Particles (WIMPs) in a wide mass-range, until neutrino interactions with the target become an irreducible background. The prompt scintillation light and the charge signals induced by particle interactions in the xenon will be observed by VUV sensitive, ultra-low background photosensors. Besides its excellent sensitivity to WIMPs above a mass of 5 GeV/c2, such a detector with its large mass, low-energy threshold and ultra-low background level will also be sensitive to other rare interactions. It will search for solar axions, galactic axion-like particles and the neutrinoless double-beta decay of 136-Xe, as well as measure the low-energy solar neutrino flux with <1% precision, observe coherent neutrino-nucleus interactions, and detect galactic supernovae. We present the concept of the DARWIN detector and discuss its physics reach, the main sources of backgrounds and the ongoing detector design and R&D efforts.
In this randomized trial of the postoperative treatment of high-risk squamous-cell carcinoma of the head and neck, concurrent radiotherapy plus chemotherapy (cisplatin) reduced the incidence of local ...and regional recurrence and prolonged disease-free survival, as compared with radiotherapy alone. The combined treatment was substantially more toxic than radiotherapy alone.
Concurrent radiotherapy plus chemotherapy (cisplatin) reduced the incidence of recurrence and prolonged disease-free survival.
Despite regimens that permit organ preservation in selected patients with advanced carcinomas of the head and neck,
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ablative surgical resection and postoperative radiotherapy are required in many patients. Typically, local or regional disease recurs in 30 percent of patients, and distant metastases appear in 25 percent; the five-year survival rate is 40 percent.
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Patients who have two or more regional lymph nodes involved, extracapsular spread of disease, or microscopically involved mucosal margins of resection have particularly high rates of local recurrence (27 to 61 percent) and distant metastases (18 to 21 percent) and a high risk of death (five-year . . .
The Head and Neck Intergroup conducted a phase III randomized trial to test the benefit of adding chemotherapy to radiation in patients with unresectable squamous cell head and neck cancer.
Eligible ...patients were randomly assigned between arm A (the control), single daily fractionated radiation (70 Gy at 2 Gy/d); arm B, identical radiation therapy with concurrent bolus cisplatin, given on days 1, 22, and 43; and arm C, a split course of single daily fractionated radiation and three cycles of concurrent infusional fluorouracil and bolus cisplatin chemotherapy, 30 Gy given with the first cycle and 30 to 40 Gy given with the third cycle. Surgical resection was encouraged if possible after the second chemotherapy cycle on arm C and, if necessary, as salvage therapy on all three treatment arms. Survival data were compared between each experimental arm and the control arm using a one-sided log-rank test.
Between 1992 and 1999, 295 patients were entered on this trial. This did not meet the accrual goal of 362 patients and resulted in premature study closure. Grade 3 or worse toxicity occurred in 52% of patients enrolled in arm A, compared with 89% enrolled in arm B (P <.0001) and 77% enrolled in arm C (P <.001). With a median follow-up of 41 months, the 3-year projected overall survival for patients enrolled in arm A is 23%, compared with 37% for arm B (P =.014) and 27% for arm C (P = not significant).
The addition of concurrent high-dose, single-agent cisplatin to conventional single daily fractionated radiation significantly improves survival, although it also increases toxicity. The loss of efficacy resulting from split-course radiation was not offset by either multiagent chemotherapy or the possibility of midcourse surgery.
Animal movements and use of space are in part determined by interactions between individual attributes such as sex and body size and extrinsic environmental factors such as the seasonal availability, ...quality and spatial configuration of resource patches in the landscape. Fire is a common and widespread disturbance process that has the potential to affect animal movements through modifications to the environment. Using radiotelemetry, we examined the contribution of these factors to variation in movements and home range over a 5‐year period in a forest‐dwelling terrestrial turtle, Terrapene carolina, at fire‐maintained and unburned habitats in the southeastern United States. Female turtles had annual home‐range sizes twice as large as males and moved longer distances per day during the nesting season (June and July), but males exhibited greater spatial fidelity from year to year. Turtles at the unburned site had home‐range sizes twice as large as those at the fire‐maintained site, and home‐range size also decreased with increasing frequency and extent of fire, but this latter effect was strongest in females. Home‐range behavior was highly repeatable within individuals of both sexes over time. This is the first evidence that fire influences the spatial ecology and movements of turtles, most likely through fire's impact on the spatial configuration, availability and quality of critical resources. That individuals behaved consistently through time, but differently from one another according to both intrinsic individual attributes and extrinsic environmental factors provides strong evidence of consistent inter‐ and intra‐population variation in space use and movement behaviors in T. carolina. Such intra‐specific behavioral variation suggests applying caution when extrapolating results to other sites across the geographic range of a species for use in conservation and management.
Prescribed fire is a common controlled disturbance practice in forest management that can affect animal interactions with their environment. We found home‐range size for a forest‐dwelling terrestrial turtle in fire‐maintained forests to be half the size of those at a nearby unburned site. Home‐range size decreased with increasing fire extent and frequency, but this effect was strongest in females. Despite strong inter‐ and intra‐population variation in space use and movements, home‐range behavior was highly repeatable within individuals over time. This is the first evidence that fire influences the spatial ecology and movements of turtles, but intra‐specific behavioral variation suggests applying caution when extrapolating results across the geographic range of a species to inform local conservation and management.
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