Summary
Identify prognostic factors for survival and patterns of treatment failure after definitive radiochemotherapy for esophageal cancer. Between 2003 and 2006, 143 patients with squamous cell ...carcinoma and adenocarcinoma of the esophagus were retrospectively reviewed. Median age was 65 years (42–81). Median radiation dose was 62.5 Gy (38–72) with 1.8–2 Gy fraction. Median follow‐up was 20.8 months (2.8–92.4). Three and 5‐year local recurrence‐free survival rates were 58.3% and 50.9%. In univariate analysis, traversable esophageal stricture was a prognostic factor. Three, 5‐year locoregional recurrence‐free survival rates were 42.4% and 34.9%. In multivariate analysis, traversable esophageal stricture and stage < IIB were independent prognostic factors. Three and 5‐year disease‐free survival rates were 30.5% and 25.9%. In multivariate analysis, Nutritional Risk Index (NRI) ≥ 97.5 and performance status (PS) = 0 were independent prognostic factors. Median, 3, and 5‐year overall survival rates were 22.1 months, 34.4%, and 19.8%. In multivariate analysis, independent prognostic factors were NRI ≥ 97.5 and PS = 0. Median survival times for the NRI classes (no denutrition, moderate and severe denutrition) were 29.5, 19.7, and 12 months (P = 0.0004), respectively. A major impact of baseline NRI was found in terms of survival; it should be included in future prospective trials.
Purpose
Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first ...echocardiography following admission to intensive care unit (ICU).
Methods
Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).
Results
Six hundred and seventy-seven patients were included and the first echo was performed 2 1, 4 days after ICU admission. The median age was 65 56, 73 years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO
2
. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU).
Conclusion
Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
Abstract Background Sellar and suprasellar primary melanocytic tumors are exceptional occurrences. Besides the difficulty of differential diagnosis between a primary and secondary lesion, treatment ...of these pathologies is still unclear and controversial. Case report We describe the case of a 36-year-old woman with no relevant previous medical history who presented with 1 month history of diabetes insipidus, blurred vision and generalized weakness; a brain MRI disclosed an atypical pituitary stalk lesion; initially the tumor was biopsied through an endonasal endoscopic approach that revealed a melanocytic tumor; the patient was afterwards managed by a second stage extended endonasal endoscopic approach achieving a subtotal tumor removal. The overall survival was of 14 months due to the multidisciplinary management including surgery, radio and chemotherapy. Conclusion If a biopsy is essential to deal with these invasive lesions, treatment including surgical resection should be part of a multidisciplinary approach.
Purpose
Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory ...distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19).
Methods
Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis.
Results
Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 0.284–0.803 times when compared to patients with all examinations depicting no ACP (
P
= 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 0.405–1.018 (
P
= 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (
P
= 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 2.38–4.45,
P
< 0.001).
Conclusion
RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
Real life study of prognostic factors of acute radiodermatitis in a monocentric cohort of 200 patients with breast cancer treated with RT3D or IMRT for adjuvant radiotherapy.
This study comprises 200 ...patients with breast cancer treated with adjuvant radiotherapy, included consecutively. For each patient, their clinical and tumoral characteristics and the irradiation schedule was retrospectively collected. The severity of acute radiodermatitis was also collected, during the treatment and 6weeks after the end of irradiation. The objective was to identify risk factors for acute radiodermatitis grade≥2.
The univariate analysis found that a more important BMI (p<0.001), a more important volume of PTV (p<0.001) a normofractionated schedule (p=0.002) were statistically associated to a greater risk of occurrence of grade≥2 acute radiodermatitis. The multivariate analysis found BMI>30 (OR=9.31, p=0.04), light phototype (OR=0.04, p=0.02) and histology other than invasive breast carcinomas (OR=0.07, p=0.04) to be statistically associated to the occurrence of grade≥2 acute radiodermatitis.
In this monocentric retrospective study, with a prospective collection of the severity of acute radiodermatitis, no grade 3 radiodermatitis has been observed and the frequency of occurrence of grade 2 radiodermatitis was lower than previously published. In contrast to previously published results, IMRT was not associated to a lower risk of grade≥2 acute radiodermatitis. Multivariate analysis found BMI, phototype, and histology to be risk factors of grade≥2 acute radiodermatitis.
New concepts of medical consultations are currently disrupting the practice of medicine. The use of standardized questionnaires, or patient-reported outcome (PRO and ePRO) has already significantly ...changed the relationship between the physician and the patient. Telemedicine, or even automatic conversational agents, such as chatbots, are also providing more convenient access to care and medical information for many patients. These tools have a major impact in oncology, precisely because of the rising chronicity of the diseases the radiation oncologists treat. In this article, we provide a detailed analysis of these new concepts.
The not-for-profit issue has been debated in November 2016 in Paris; this issue is one of the four canonical pillars of ethical blood donation. It is intimately bound to benevolence though it is ...distinct, as not-for-profit calls for institutions while benevolence calls for individuals. It is indeed intended that voluntary blood donors do not benefit from their donation and are thus non-remunerated. Not-for-profit is essential since it refers to the public character of blood as a putative public resource aimed at being shared as a tribute of solidarity. A central question however is linked to the capacity- or not -of public sectors to ensure that blood components are universally available, with special mention to plasma derived drugs, without the contribution of the for profit, private sector.
Bevacizumab and stereotactic treatment are efficient combined or alone in relapse glioma. However, patterns of relapse after this kind of salvage treatment have never been studied. The purpose of ...this unicentric retrospective analysis was to assess and understand the patterns of relapse of high grade glioma treated with stereotactic radiation, with or without bevacizumab.
Twenty patients with high grade glioma relapse received a stereotactic radiation; among them two patients received temozolomide and eight patients received bevacizumab; among the latter, four received also irinotecan. We matched the stereotactic radiation treatment planning scan with the images of the first treatment and of the second relapse in order to determine the patterns of failure and associate dosimetric profile.
For the total population, median follow-up from the first diagnosis and relapse were 46.1 and 17.6 months, respectively. Among the 13 patients who relapsed, ten did not receive chemotherapy and three received it (P<0.05), two received temozolomide and one bevacizumab. Patients who received bevacizumab had no “out-of-field” recurrences. Among the 32 irradiated relapses, 15 were “in-field” recurrences; among them two were treated with bevacizumab and 13 were not (P<0.05). For the 32 lesions, a favourable prognostic factor of control was the association of a high-dose of irradiation and the use of bevacizumab.
For patients with relapsed high grade glioma, local control was higher with combined bevacizumab and high-dose stereotactic radiation.
Le bévacizumab et l’irradiation en conditions stéréotaxiques sont deux traitements efficaces, seuls ou associés, pour les gliomes en rechute. Cependant, les sites de rechute après ce type de traitement n’ont jamais été étudiés. L’objectif de cette étude unicentrique rétrospective était d’identifier les sites de rechute des gliomes de haut grade après un traitement de rattrapage par irradiation en conditions stéréotaxiques avec ou sans bévacizumab.
Vingt patients atteints d’un gliome de haut grade en récidive ont reçu une irradiation en conditions stéréotaxiques ; parmi ces patients, dix ont reçu une chimiothérapie concomitante : deux par témozolomide et huit par bévacizumab, dont pour quatre associé à l’irinotécan. Nous avons recalé l’IRM réalisée avant le traitement initial, celle avant la réirradiation et celle au moment de la rechute. La distribution de dose du traitement initial et de l’irradiation en conditions stéréotaxiques ont été reportées sur les coupes remnographiques, la première sur celles réalisées avant la réirradiation et celles au moment de la rechute et la seconde sur celles réalisées avant le traitement initial et celles au moment de la rechute. Nous avons pu ainsi déterminer les sites de récidive en fonction des différentes dosimétries et y associer les profils de doses reçues.
Le suivi médian après la rechute réirradiée était de 17,6 mois. Treize tumeurs ont rechuté. Dix patients n’avaient pas eu de chimiothérapie, deux avaient reçu du témozolomide et un du bévacizumab (p<0,05). Aucun patient ayant reçu de la chimiothérapie n’a été atteint de rechute en dehors du site réirradié. Parmi les 32 lésions irradiées, il y a eu 15 rechutes locales. Deux de ces lésions avaient été traitées par bévacizumab et 13 non. Pour ce qui concerne les 32 lésions, le facteur pronostique favorable de contrôle local était une association d’une haute dose de radiothérapie et de bévacizumab.
Les patients atteints d’une rechute de gliome de haut grade traitée par irradiation en conditions stéréotaxiques de haute dose et le bévacizumab ont bénéficié d’un meilleur taux de contrôle local.
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