389 research outputs found
'I want him to be a better person than his dad was' How mothers experience their relationship with their son following Domestic Violence
The impact of institutional clinical trial recruitment versus hospital volume on survival outcomes of patients with head and neck cancer:An analysis of the PET-NECK trial outcomes, UKCRN portfolio, and Hospital Episode Statistics (HES) in England
Chronic allograft nephropathy
Chronic allograft nephropathy (CAN) is the leading cause of renal allograft loss in paediatric renal transplant recipients. CAN is the result of immunological and nonimmunological injury, including acute rejection episodes, hypoperfusion, ischaemia reperfusion, calcineurin toxicity, infection and recurrent disease. The development of CAN is often insidious and may be preceded by subclinical rejection in a well-functioning allograft. Classification of CAN is histological using the Banff classification of renal allograft pathology with classic findings of interstitial fibrosis, tubular atrophy, glomerulosclerosis, fibrointimal hyperplasia and arteriolar hyalinosis. Although improvement in immunosuppression has led to greater 1-year graft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectious complications remain a problem. Protocol biopsy monitoring is not current practice in paediatric transplantation for CAN monitoring but may have a place if new treatment options become available. Newer immunosuppression regimens, closer monitoring of the renal allograft and management of subclinical rejection may lead to reduced immune injury leading to CAN in the paediatric population but must be weighed against the risk of increased immunosuppression and calcineurin inhibitor nephrotoxicity
Effect of pathologic tumor response and nodal status on survival in the medical research council adjuvant gastric infusional chemotherapy trial
Purpose: The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial. Materials and Methods: Pathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS. Results: Three hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P < .001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P < .001). Conclusion: Lymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate
Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial
Background
Whole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from
non-small cell lung cancer (NSCLC), although there have been no randomised clinical trials showing that WBRT
improves either quality of life or overall survival. Even after treatment with WBRT, the prognosis of this patient group
is poor. We aimed to establish whether WBRT could be omitted without a signifi cant eff ect on survival or quality of life.
Methods
The Quality of Life after Treatment for Brain Metastases (QUARTZ) study is a non-inferiority, phase 3
randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for
surgical resection or stereotactic radiotherapy were randomly assigned (1:1) to optimal supportive care (OSC)
including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone (including dexamethasone). The
dose of dexamethasone was determined by the patients’ symptoms and titrated downwards if symptoms improved.
Allocation to treatment group was done by a phone call from the hospital to the Medical Research Council Clinical
Trials Unit at University College London using a minimisation programme with a random element and stratifi cation
by centre, Karnofsky Performance Status (KPS), gender, status of brain metastases, and the status of primary lung
cancer. The primary outcome measure was quality-adjusted life-years (QALYs). QALYs were generated from overall
survival and patients’ weekly completion of the EQ-5D questionnaire. Treatment with OSC alone was considered noninferior
if it was no more than 7 QALY days worse than treatment with WBRT plus OSC, which required 534 patients
(80% power, 5% [one-sided] signifi cance level). Analysis was done by intention to treat for all randomly assigned
patients. The trial is registered with ISRCTN, number ISRCTN3826061.
Findings
Between March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian
centres, and were randomly assigned to receive either OSC plus WBRT (269) or OSC alone (269). Baseline characteristics
were balanced between groups, and the median age of participants was 66 years (range 38–85). Signifi cantly more
episodes of drowsiness, hair loss, nausea, and dry or itchy scalp were reported while patients were receiving WBRT,
although there was no evidence of a difference in the rate of serious adverse events between the two groups. There was
no evidence of a diff erence in overall survival (hazard ratio 1·06, 95% CI 0·90–1·26), overall quality of life, or
dexamethasone use between the two groups. The diff erence between the mean QALYs was 4·7 days (46·4 QALY days
for the OSC plus WBRT group vs 41·7 QALY days for the OSC group), with two-sided 90% CI of –12·7 to 3·3.
Interpretation
Although the primary outcome measure result includes the prespecifi ed non-inferiority margin, the
combination of the small diff erence in QALYs and the absence of a diff erence in survival and quality of life between
the two groups suggests that WBRT provides little additional clinically signifi cant benefi t for this patient group
PATCH - Prostate adenocarcinoma: transcutaneous hormones. A randomised comparison evaluating cardiovascular morbidity and mortality of transdermal oestradiol versus luteinising hormone-releasing hormone agonists in advanced prostate cancer
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