Combined use of hyperthermia and radiation therapy for treating locally advanced cervical carcinoma (Withdrawn Paper, art. no. CD006377, 2010)

Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It was introduced into clinical oncology practice several decades ago. Positive clinical results, mostly obtained in single institutions, resulted in clinical implementation albeit in a limited number of cancer centres worldwide. Because large scale randomised clinical trials (RCTs) are lacking, firm conclusions cannot be drawn regarding its definitive role as an adjunct to radiotherapy in the treatment of locally advanced cervical carcinoma (LACC).To assess whether adding hyperthermia to standard radiotherapy for LACC has an impact on (1) local tumour control, (2) survival and (3) treatment related morbidity.The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), (Issue 1, 2009) and Cochrane Gynaecological Cancer Groups Specialised Register, MEDLINE, EMBASE, online databases for trial registration, handsearching of journals and conference abstracts, reviews, reference lists, and contacts with experts were used to identify potentially eligible trials, published and unpublished until January 2009.RCTs comparing radiotherapy alone (RT) versus combined hyperthermia and radiotherapy (RHT) in patients with LACC.Between 1987 and 2009 the results of six RCTs were published, these were used for the current analysis.74% of patients had FIGO stage IIIB LACC. Treatment outcome was significantly better for patients receiving the combined treatment (Figures 1 to 3). The pooled data analysis yielded a significantly higher complete response rate (relative risk (RR) 0.56; 95% confidence interval (CI) 0.39 to 0.79; p <0.001), a significantly reduced local recurrence rate at 3 years (hazard ratio (HR) 0.48; 95% CI 0.37 to 0.63; p <0.001) and a significanly better overall survival (OS) at three years following the combined treatment with RHT(HR 0.67; 95% CI 0.45 to 0.99; p = 0.05). No significant difference was observed in treatment related acute (RR 0.99; 95% CI 0.30 to 3.31; p = 0.99) or late grade 3 to 4 toxicity (RR 1.01; CI 95% 0.44 to 2.30; p = 0.96) between both treatments.The limited number of patients available for analysis, methodological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to standard radiotherapy. However, available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervical carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity

Cambio demográfico, migración y salud reproductiva : el papel de las mujeres senegalesas en la constitución de las familias

En aquest paper presentem en primer lloc els trets més característics de la transició de la nupcialitat i de la fecunditat a Senegal fent referència a alguns indicadors de la salut sexual i reproductiva de les dones. A continuació presentem els indicadors que resumeixen la biografia migratòria, nupcial i reproductiva d'un col·lectiu de dones senegaleses que han immigrat a Catalunya i que estan construint les seves famílies a cavall de dues cultures i de dos continents, fent referència entre altres coses a la poligamia, al lloc de naixement i residència dels seus fills i a la utilització de mètodes de planificació familiar. Acabem la comunicació amb algunes reflexions sobre el paper de les dones com agents actius en les decisions en materia de sexualitat i reproducció, en una societat que no és la seva, de la qual agraeixen els serveis de salut públics però sense deixar de banda la seva pròpia concepció de la família i de la salut.En este artículo presentamos en primer lugar los elementos más rellevantes de la transición de la nupcialidad y de la fecundidad en Senegal haciendo referencia a algunos indicadores de salud sexual y reproductiva de las mujeres. A continuación presentamos los indicadores que resumen la biografía migratoria, nupcial y reproductiva de un colectivo de mujeres de Senegal que han inmigrado a Cataluña y que están formando sus familias en el contexto de dos culturas y de dos continentes, haciendo referencia entre otras cosas a la poligamia, al lugar de nacimiento y residencia de sus hijos y a la utilización de métodos de planificación familiar. Finalizamos la comunicación con algunas reflexiones sobre el papel de las mujeres como agentes activos en las decisiones en materia de sexualidad y reproducción, en una sociedad que no es la suya propia, de la que agradecen los servicios de salud públicos pero sin olvidar su propia concepción de la familia y de la salud.In this paper we present the main characteristics from Senegal's nuptuality and fertility transition according to a group of measures related to women's sexual and reproductive health. We then show those indicators that summarise Senegal's women biography in terms of their migration, nuptuality and reproduction for those who have immigrated to Catalunya and have to raise a family between two cultures and two continents. In this way the article makes reference, among other things, to polygamy, the birthplace and residence of their offspring, as well as the existence of family planning. Lastly, we finish this paper with some ideas about the role of Senegal's women making sexual and reproduction decisions in a different society where they can obtain public health services while keeping their own approach to family and health issues

Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention

<p>Abstract</p> <p>Background</p> <p>There have been few prospective observational studies which recruited older newly-diagnosed cancer patients, and of these only some have reported information on the number needed to screen to recruit their study sample, and the number and reasons for refusal and drop-out. This paper reports on strategies to recruit older newly-diagnosed cancer patients prior to treatment into an observational prospective pilot study and to retain them during a six-month period.</p> <p>Methods</p> <p>Medical charts of all patients in the Segal Cancer Centre aged 65 and over were screened and evaluated for inclusion. Several strategies to facilitate recruitment and retention were implemented. Reasons for exclusion, refusal and loss to follow-up were recorded. Descriptive statistics were used to report the reasons for refusal and loss to follow-up. A non-response analysis using chi-square tests and t-tests was conducted to compare respondents to those who refused to participate and to compare those who completed the study to those who were lost to follow-up. A feedback form with open-ended questions was administered following the last interview to obtain patient's opinions on the length of the interviews and conduct of this pilot study.</p> <p>Results</p> <p>3060 medical charts were screened and 156 eligible patients were identified. Of these 112 patients participated for a response rate of 72%. Reasons for refusal were: feeling too anxious (40%), not interested (25%), no time (12.5%), too sick (5%) or too healthy (5%) or other reasons (5%). Ninety-one patients participated in the six-month follow-up (retention 81.3%), seven patients refused follow-up (6.2%) and fourteen patients died (12.5%) during the course of the study. The median time to conduct the baseline interview was 45 minutes and 57% of baseline interviews were conducted at home. Most patients enjoyed participation and only five felt that the interviews were too long.</p> <p>Conclusion</p> <p>It was feasible to recruit newly-diagnosed cancer patients prior to treatment although it required considerable time and effort. Once patients were included, the retention rate was high despite the fact that most were undergoing active cancer treatment.</p

Clinical development of new drug-radiotherapy combinations.

In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.National Institute for Health ResearchThis is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/nrclinonc.2016.7