Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Analysis of late adverse events and their chronological changes after radiation therapy for cervical cancer

Several late adverse events occur after radiation therapy (RT) for cervical cancer. However, there has been little reported about their chronological changes. It is still unclear whether concurrent chemoradiotherapy (CCRT) increases late complications. We aimed to evaluate the late adverse events and their chronological changes and whether CCRT increases their incidence and severity. For this purpose, we retrospectively analyzed 157 women with histologically proven cervical cancer. We reviewed all late adverse events and compared the frequency and severity between the patients who underwent CCRT and those who underwent RT alone. We calculated the cumulative occurrence rates of late adverse events stratified by the site and severity, and determined the chronological changes. With survivors’ median follow-up time of 74.3 months, late adverse events occurred in 49.0% and serious complications developed in 24.2% of all patients. There was no significant difference in the cumulative incidence rate of all late adverse events between the CCRT and RT-alone groups (p = 0.720). The incidence rate of rectal bleeding was 25.5%. Serious rectal bleeding developed in 5 patients, all within 20 months from the start of RT. Importantly, the symptoms of rectal bleeding disappeared or were relieved in most patients during follow-up. In conclusion, we evaluated the late adverse events and their chronological changes after RT for cervical cancer and showed that adding chemotherapy to RT did not affect the frequency and severity of late complications, and the symptoms of rectal bleeding were relieved over time

Does uterine preservation affect survival outcomes of patients with stage I ovarian sex cord-stromal cell tumours? A multi-institutional study

Objective: Sex cord-stromal tumours of the ovary are relatively uncommon neoplasms that account for 3 % of all ovarian cancers. Uterine preservation with careful staging is achievable; however, conservative surgery remains controversial. This study examined the prognostic effects of uterine preservation in patients with stage I sex cord-stromal tumours. Study design: This retrospective cohort study was undertaken between January 1986 and February 2019, and the clinicopathological data of 4897 women with malignant ovarian tumours were collected. Seventy-seven patients with stage I sex cord-stromal tumours were eligible for inclusion. The characteristics and survival outcomes of these patients were examined. To investigate the prognostic effects of uterine-preserving surgery, baseline imbalances between patients with and without uterine-preserving surgery were adjusted using an inverse probability of treatment weighting with propensity scores composed of independent clinical variables. Results: The mean ages of patients in the uterine-preserving surgery and non-uterine-preserving surgery groups were 39.8 and 57.8 years, respectively. After inverse probability of treatment weighting adjustments, no significant differences in overall survival (p = 0.205) or recurrence-free survival (p=0.071) were observed between the uterine-preserving surgery and non-uterine-preserving surgery groups. Estimated 10-year overall survival rates were 98.7 % in the uterine-preserving surgery group and 95.9 % in the non-uterine-preserving surgery group, and 10-year recurrence-free survival rates were 87.2 % in the uterine-preserving surgery group and 78.2 % in the non-uterine-preserving surgery group. Uterine-preserving surgery did not significantly affect the site of tumour recurrence. Conclusion: Uterine-preserving surgery may be a feasible surgical option for patients with stage I sex cord-stromal tumours. Further research is needed to guarantee prognostic accuracy and develop effective therapeutic approaches for sex cord-stromal tumours