Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review

BACKGROUND AND OBJECTIVE: In recent years, the role of positron emission tomography (PET) in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. DESIGN AND SETTING: Systematic literature review. METHODS: Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. RESULTS: PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered paraaortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of “adaptive” brachytherapy in cervical cancer. CONCLUSIONS: This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure

Periurethral adenocarcinoma of mesonephric origin: A case report and review of the literature

Periurethral mesonephric adenocarcinoma is a rare tumor. To the best of our knowledge, only 13 cases have been reported in the literature to date. We report the case of a 36-year-old lady who presented with periurethral mesonephric adenocarcinoma, treated by surgery followed by adjuvant chemotherapy and pelvic radiotherapy. We demonstrate the unusual histology of mesonephric adenocarcinoma and the necessity to consider this tumor in the differential diagnosis of all unusual genito-urologic tumours. In the present literature, combination of surgery followed by chemotherapy and radiotherapy is the most suitable treatment for locally advanced periurethral mesonephric adenocarcinoma. Keywords: Mesonephric, Adenocarcinoma, Periurethral, Radical cystectom

Breastfeeding attitudes and knowledge among sixth year medical students in Jordan

Background: Previous reports have demonstrated that counseling about breastfeeding can improve the rate and initiation duration of breastfeeding. However, those medical students are ill-prepared for this role. It is unclear whether medical students would provide the knowledge and skills necessary for effective breastfeeding promotion or not in Jordan. The aim of this study was to identify breastfeeding attitudes and knowledge among 6th year medical students in their final year at The Jordan University of Science and Technology (JUST).Methods: A 28-item self-administered questionnaire; containing three sections: knowledge (13 items) attitude (7 items) and demographic (3 items), were distributed randomly to medical students. The random sample consisted of 234 medical students who were in their final year. The questionnaire assessed both breastfeeding attitudes and knowledge.Results: The results were explained taking into consideration gender and being a parent. Mean attitude's score for participants without children was 46.7 as compared to 44.0 for those with children. The results showed similar negative attitude toward breastfeeding among both male and female participants regardless of having children or not (p=0.35). This means that there were no significant difference in attitudes toward breastfeeding among male and female students whether they are having children or not. On the other hand, the mean knowledge score was 22.9 for male participants while it was 21.55 for female participants, indicating some degree of breastfeeding knowledge among participants (p=0.035). However, having personal experience with breastfeeding (self or partner) did not increased breastfeeding attitudes and knowledge (p=0.35 vs. p=0.93, respectively).Conclusions: Medical students have significant educational needs in the area of breastfeeding management and breastfeeding education. Further targeted training is needed to improve both breastfeeding attitudes and knowledge

Patterns of recurrence and disease-free survival in advanced squamous cell carcinoma of the vulva

Objective. To compare patterns of recurrence and disease-free survival (DFS) of node-positive and node-negative patients with advanced vulval squamous cell carcinoma (SCC)

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Background: Intensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care. Methods: A retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h during pregnancy or less than 6 weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7 days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration. Results: Overall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24 h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of −0.11, 95% CI −0.13 to −0.08). Conclusions: The CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk.Medicine, Faculty ofOther UBCNon UBCAnesthesiology, Pharmacology and Therapeutics, Department ofFamily Practice, Department ofMedicine, Department ofObstetrics and Gynaecology, Department ofReviewedFacult