Endovascular Ablation Therapies for Varicose Veins in Elderly Patients

Background: Varicose veins are a common vascular disease in elderly patients. Both endovascular laser ablation (EVLA) and radiofrequency ablation (RFA) are reported to have good technical, clinical, and patient-reported outcomes for the treatment of varicose veins. We did not find any reports on treating elderly patients with endovascular ablation procedures in the literature. The aim of this study was to determine whether endovenous thermal ablation techniques are safe and effective in treating elderly patients with varicose veins. Method: A retrospective analysis of 57 EVLA cases and 46 RFA cases was conducted at a single center. Patients in the 65–88-year age group were assessed for postoperative pain, hematoma, thrombophlebitis, hyperpigmentation, wound infection, and skin burn. Results: Minor complications identified in the studied patients were hematoma (2.9%), thrombophlebitis (5.8%), hyperpigmentation (8.7%), wound infection (4.9%), and skin burn (1%). In the RFA group, 38 patients (83%) had no need for oral analgesic tablets on postoperative Day 3. In the EVLA group, 25 patients (44%) had no need for oral analgesic tablets on postoperative Day 3. Two patients in the EVLA group needed a secondary intervention due to recurrent vein issues. There were no major complications in either group. Conclusion: The outcomes for our older patients who underwent endovascular ablation therapy were comparable to other studies performed with the general population. Our results show that both EVLA and RFA are feasible, safe, and well-tolerated by elderly patients

A Single Institution Experience of Incorporation of Cisplatin into Adjuvant Chemotherapy for Patients With Triple-Negative Breast Cancer of Unknown Mutation Status

The clinical benefit of adding platinum to adjuvant chemotherapy for patients with triple-negative breast cancer (TNBC) has not been well investigated, although it was associated an improved response rate in neoadjuvant setting. We retrospectively analyzed the time to tumor progression (TTP) and overall survival (OS) of patients with resected stage I-III TNBC who were treated with or without cisplatin-containing chemotherapy (CisCT or noCisCT) during 2004 and 2010. Of 129 patients, 25 received CisCT. In univariate analysis, the mean TTP for CisCT and noCisCT was 4.42 and 5.88 years, respectively ( P  = .004). The mean OS for CisCT and noCisCT was 6.76 and 9.63 years, respectively ( P  = .24). After adjusting for other clinicopathologic factors, only clinical stage II/III disease was independently associated with worse OS. The adjusted hazard ratio for CisCT was 1.48 ( P  = .46) and was not statistically significant. In this small retrospective study, adding cisplatin to adjuvant chemotherapy for early TNBC with unknown BRCA mutation status did not benefit OS

Electro-acupuncture for central obesity: a patient-assessor blinded, randomized sham-controlled clinical trial

Abstract Background Central obesity is considered as a significant health threat to individuals. Scientific research has demonstrated that intra-abdominal fat accumulation is associated with higher metabolic and cardiovascular disease risks independent of Body Mass Index (BMI). This study aimed to evaluate the efficacy and safety of electro-acupuncture in treating central obesity compared with sham acupuncture. Method This was a patient-assessor blinded, randomized, sham-controlled clinical trial. One hundred sixty eight participants aged between 18 and 65 years old with BMI ≥ 25 kg/m2 and waist circumference (WC) of men ≥ 90 cm / women ≥ 80 cm were enrolled and allocated to the acupuncture or sham acupuncture group equally. For the acupuncture group, disposable acupuncture needles were inserted into eight body acupoints, including Tianshu (ST-25), Daheng (SP-15), Daimai (GB-26), Qihai (CV-6), Zhongwan (CV-12), Zusanli (ST-36), Fenglong (ST-40), and Sanyinjiao (SP-6) with electrical stimulation. For the control group, Streitberger’s non-invasive acupuncture needles were utilized at the same acupoints with identical stimulation modalities. The treatment duration was 8 weeks with 2 sessions per week and the follow-up period was 8 weeks. The primary outcome was the change in WC before and after the treatment. The secondary outcomes were the changes in hip circumference, waist-to-hip circumference ratio, BMI, and body fat percentage during the treatment and follow-up period. Results The acupuncture group displayed a significant change in WC compared to the sham group both treatment and follow-up period (MD = -1.1 cm, 95% CI = -2.8 to 4.1). Significant change in body fat percentage was recorded for both groups after treatment but no significance was observed during the follow-up period (MD = -0.1%, 95% CI = -1.9 to 2.2). The changes in hip circumference were also significant both treatment and follow-up period for the acupuncture group (MD = -2.0 cm, 95% CI = -3.7 to -1.7). Compared with sham acupuncture, the body weight (MD = -1 kg, 95% CI = -3.3 to 5.3), BMI (MD = -0.5, 95% CI = -0.7 to 1.9) also decreased significantly within and between groups. The incidence of adverse events was similar in the two groups. Conclusion This study provided evidence that electro-acupuncture could be effective in treating central obesity by reducing WC, hip circumference, body weight, BMI, and waist-to-hip circumference ratio. Trial registration ClinicalTrials.gov Identifier: NCT03815253, Registered 24 Jan 2019

Multi-center study on patient selection for and the oncologic safety of intraoperative radiotherapy (IORT) with the Xoft Axxent® eBx® System for the management of early stage breast cancer in Taiwan

<div><p>Background</p><p>In this multi-center study, we report the patient selection criteria for and preliminary oncologic outcomes associated with intraoperative radiotherapy (IORT) delivered by the Xoft Axxent® eBx® system for early-stage breast cancer in Taiwan.</p><p>Methods</p><p>Patients with early breast cancer in Taiwan received breast conserving surgery and received IORT with Xoft Axxent® eBx® System during 2013–2015 was search from database of Taiwan IORT study cooperative group (T-IORTSCG). Patients’ clinicopathologic characteristics and early post-operative results were collected and reported.</p><p>Results</p><p>During the study period, 26 hospitals in Taiwan performed a total of 261 Xoft IORT procedures for breast cancer. The mean age of them was 52.9 ± 9.8 years (37–72), and tumor size was 1.5 ± 0.8 cm (0.1–4.2 cm) for invasive cancer and 1.2 ± 0.8 cm (range, 0.2–3.0 cm) for ductal carcinoma in situ (DCIS) lesions. Lymph node metastasis was found in 6 (2.3%) patients. The patients received IORT in Taiwan differed markedly from those used in the ELIOT and TARGIT-A studies. Specifically, patients selected for IORT in Taiwan tended to be younger, their tumors tended to be larger and the prevalence of lymph node metastasis tended to be lower. Among these 261 patients, 8 (3.1%) patients required whole breast radiotherapy. During a mean follow up of 15.6 months, locoregional recurrence was observed in 2 (0.8%) patients.</p><p>Conclusion</p><p>In real world experience, patients received IORT differed quite significantly with criteria formulated by trials. The preliminary results of IORT in Taiwan showed it is well acceptable by patients and clinicians.</p></div

The development and application of Xoft IORT system in Taiwan.

<p>(a) The development and application of Xoft IORT system in Taiwan from 2013–2015. The T-IORTSCG comprises members from major IORT centers in Taiwan, and included 5 centers in 2013, 18 in 2014, and 26 in 2015. The number of IORT performed per year and the cumulative number of IORT performed in the past 3 years were provided. (b) Illustration of pre- and post-operative breast appearance of patients received conventional radiotherapy. (c) Illustration of pre- and post-operative breast appearance of patients received intra-operative radiotherapy.</p

Comparison of patients selection criteria of Xoft IORT in Taiwan with ELIOT and TARGIT-A trials.

<p>Comparison of patients selection criteria of Xoft IORT in Taiwan with ELIOT and TARGIT-A trials.</p

Timing and types of intra-operative radiotherapy (IORT) performed.

<p>Timing and types of intra-operative radiotherapy (IORT) performed.</p

Procedures for patients received intra-operative radiotherapy with the Xoft Axxent® eBx® delivery system.

<p>(a) The eBX system consists of a balloon applicator, a 50-kV source, and a mobile, highly portable controller unit that can be easily transported to any treatment room or standard operating room. (b) The chest wall shield was placed temporarily into the cavity for the duration of radiation treatment to protect the underlying heart, ribs, and lungs from scattered radiation. (c) A balloon-like cavity evaluation device was then placed through a lateral stab wound incision or directly into the wound and filled to a desired volume of 30–75 cc, based on the radiation treatment plan. (d) Once the cavity volume was determined, an appropriate size of eBX balloon was opened up and inserted into the cavity. Multiple retention-type sutures were used to maintain the balloon-to-tissue apposition and to temporarily close the lumpectomy cavity around the balloon. (e) Balloon-to-tissue conformity was assessed by intraoperative ultrasonography to ensure that the target volume did not contain air or fluid. Intraoperative ultrasonography was then used to confirm that there was a distance of at least 1 cm between the balloon and skin to reduce the risk of radionecrosis. (f) A FlexiShieldTM (FS; Xoft, Inc., San Jose, CA) was placed over the breast to minimize transmission of radiation to the patient and hospital staff. (g) The radiation source was inserted into the balloon and radiation therapy was initiated. A planned dose of 20 Gy to the balloon surface was delivered over an average of 8–15 mins. (h) During treatment, the surgeon, radiation oncologists, anesthesiologist, and other essential operating room personnel wore standard lead aprons and /or stood behind a portable radiation shield in the operating suite. The medical staffs could also leave the operation room and observe the monitors during the Xoft IORT treatment.</p