scholarly journals Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthias Balk ◽  
Robin Rupp ◽  
Konstantin Mantsopoulos ◽  
Moritz Allner ◽  
Philipp Grundtner ◽  
...  
Keyword(s):  
Survival Rate ◽  
Adjuvant Therapy ◽  
Head And Neck ◽  
Neck Dissection ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Oncologic Outcome ◽  
Time Interval ◽  
Median Time Interval ◽  
The Impact

Abstract Introduction In contrast to head and neck squamous cell carcinoma (HNSCC), the effect of treatment duration in HNSCC-CUP has not been thoroughly investigated. Thus, this study aimed to assess the impact of the time interval between surgery and adjuvant therapy on the oncologic outcome, in particular the 5-year overall survival rate (OS), in advanced stage, HPV-negative CUPs at a tertiary referral hospital. 5-year disease specific survival rate (DSS) and progression free survival rate (PFS) are defined as secondary objectives. Material and methods Between January 1st, 2007, and March 31st, 2020 a total of 131 patients with CUP were treated. Out of these, 59 patients with a confirmed negative p16 analysis were referred to a so-called CUP-panendoscopy with simultaneous unilateral neck dissection followed by adjuvant therapy. The cut-off between tumor removal and delivery of adjuvant therapy was set at the median, i.e. patients receiving adjuvant therapy below or above the median time interval. Results Depending on the median time interval of 55 days (d) (95% CI 51.42–84.52), 30 patients received adjuvant therapy within 55 d (mean 41.69 d, SD = 9.03) after surgery in contrast to 29 patients at least after 55 d (mean 73.21 d, SD = 19.16). All patients involved in the study were diagnosed in advanced tumor stages UICC III (n = 4; 6.8%), IVA (n = 27; 45.8%) and IVB (n = 28; 47.5%). Every patient was treated with curative neck dissection. Adjuvant chemo (immune) radiation was performed in 55 patients (93.2%), 4 patients (6.8%) underwent adjuvant radiation only. The mean follow-up time was 43.6 months (SD = 36.7 months). The 5-year OS rate for all patients involved was 71% (95% CI 0.55–0.86). For those patients receiving adjuvant therapy within 55 d (77, 95% CI 0.48–1.06) the OS rate was higher, yet not significantly different from those with delayed treatment (64, 95% CI 0.42–0.80; X2(1) = 1.16, p = 0.281). Regarding all patients, the 5-year DSS rate was 86% (95% CI 0.75–0.96). Patients submitted to adjuvant treatment in less than 55 d the DSS rate was 95% (95% CI 0.89–1.01) compared to patients submitted to adjuvant treatment equal or later than 55 d (76% (95% CI 0.57–0.95; X2(1) = 2.32, p = 0.128). The 5-year PFS rate of the entire cohort was 72% (95% CI 0.59–0.85). In the group < 55 d the PFS rate was 78% (95% CI 0.63–0.94) and thus not significantly different from 65% (95% CI 0.45–0.85) of the group ≥55 d; (X2(1) = 0.29, p = 0.589). Conclusions The results presented suggest that the oncologic outcome of patients with advanced, HPV-negative CUP of the head and neck was not significantly affected by a prolonged period between surgery and adjuvant therapy. Nevertheless, oncologic outcome tends to be superior for early adjuvant therapy.

Abstract 13248: The Impact of Instructions for Covering the Mouth and the Nose on Dispatch-Assisted Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hidetada Fukushima ◽  
Hideki Asai ◽  
Koji Yamamoto ◽  
Yasuyuki Kawai
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Median Time ◽  
Chest Compression ◽  
Fire Department ◽  
Emergency Call ◽  
Time Interval ◽  
Time Intervals ◽  
Median Time Interval ◽  
Study Results ◽  
The Impact

Introduction: Under the SARS-CoV-2 pandemic, rescuers are recommended to cover their mouth and nose with a facemask or a cloth as well as victim’s mouth and nose when performing cardiopulmonary resuscitation (CPR). However, its impact on dispatch-assisted CPR (DACPR) has not been investigated well. Hypothesis: DACPR including the instruction for covering the rescuer’s and the victim’s mouth and nose can significantly delay the start of the first chest compression. Methods: We retrospectively analyzed DACPR records of the Nara Wide Area Fire Department, covering population of 853,000/3361km 2 , in Japan. We investigated the key time intervals of 505 DACPR records between May 2020 and March 2021. We also compared the results to that of the same period in 2019 (535 records). Results: Dispatchers failed to provide mask instruction in 322 cases (63.8%). The median time interval from the emergency call and the start of CPR instruction was longer in 2020 (197 seconds vs 190 seconds, p=0.641). The time to the first chest compression was also delayed in 2020 (264 seconds vs 246 seconds, p=0.015). Among the cases that dispatchers successfully provided mask instruction (183 cases, 36.2%), median time intervals to the start of instruction and the first chest compression were relatively faster than cases without mask instruction (177 seconds vs 211 seconds and 254 seconds vs 269.5 seconds, respectively). Conclusions: Dispatchers failed to provide mask instruction in the majority of CA cases. However, our study results indicate that the impact of mask instruction on DACPR can be minor in terms of immediate CPR provision.

scholarly journals The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

2021 ◽  
Author(s):  
Matthew Parsons ◽  
Shane Lloyd ◽  
Skyler Johnson ◽  
Courtney Scaife ◽  
Heloisa Soares ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Treatment Delays ◽  
Doubly Robust Estimation ◽  
Doubly Robust ◽  
The Impact

Abstract Purpose: To understand factors associated with timing of adjuvant therapy for cholangiocarcinoma and the impact of delays on overall survival (OS).Methods: Data from the National Cancer Database (NCDB) for patients with non-metastatic bile duct cancer from 2004 to 2015 were analyzed. Patients were included only if they underwent surgery and adjuvant chemotherapy and/or radiotherapy (RT). Patients who underwent neoadjuvant or palliative treatments were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients initiating therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling.Results: In total, 7,733 of 17,363 (45%) patients underwent adjuvant treatment. The median time to adjuvant therapy initiation was 59 days (interquartile range 45-78 days). Age over 65, black and Hispanic race, and treatment with RT alone were associated with later initiation of adjuvant treatment. Patients with larger tumors and high grade disease were more likely to initiate treatment early. After propensity score weighting, there was an OS decrement to initiation of treatment beyond the median of 59 days after surgery. Conclusions: We identified characteristics that are related to the timing of adjuvant therapy in patients with biliary cancers. There was an OS decrement associated with delays beyond the median time point of 59 days. This finding may be especially relevant given the treatment delays seen as a result of COVID-19.

Recurrent disease in patients with stage III melanoma in the era of adjuvant immune and targeted therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21570-e21570
Author(s):  
Victor Lo ◽  
Valerie Francescutti ◽  
Elaine McWhirter ◽  
Forough Farrokhyar ◽  
Linda May Lee
Keyword(s):  
Targeted Therapy ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Systemic Therapy ◽  
Recurrent Disease ◽  
Stage Iii ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Stage Iii Melanoma

e21570 Background: Advancements in systemic therapy have reduced recurrence, and the adoption of nodal surveillance in place of dissection has reduced morbidity for patients with Stage III melanoma. The objective of this study was to describe the timing and pattern of recurrence in stage III melanoma patients and evaluate the impact of adjuvant treatment and nodal surveillance. Methods: A multicenter retrospective chart review of patients with pathologically confirmed Stage III cutaneous melanoma seen at either the Juravinski Cancer Centre or Walker Family Cancer Centre in Ontario, Canada from January 1, 2017 to December 31, 2019. Results: There were 137 patients with Stage III melanoma: 18% IIIA, 22% IIIB, 52% IIIC, and 8% Stage IIID as per the 8th American Joint Committee on Cancer (AJCC) 2018 staging system. 103 (75%) patients had sentinel lymph node biopsy (SLNB) only as part of initial surgical therapy, 6 (4%) had SLNB with completion dissection, and 25 (18%) had upfront radical nodal dissection. 67 (49%) patients received adjuvant therapy, of which 50 (74%) had immunotherapy, 17 (25%) received BRAF-targeted therapy, and 1 (1%) had interferon. 54 (39%) patients developed recurrent disease, with a median time to recurrence of 8.5 months (IQR: 4.3-14.9). The recurrence rates were 63% in patients who did not have adjuvant treatment and 37% in those who had adjuvant therapy, with a median time-to-recurrence of 7.5 and 9.0 months respectively. There were 30 (56%) loco-regional recurrences and 24 (44%) distant recurrences. Of the patients with loco-regional recurrence, 26 (87%) had SLNB only compared to 4 (13%) who had upfront or completion dissection. 12 (24%) patients recurred while on adjuvant treatment (7 distant recurrences and 5 loco-regional recurrences), and 8 (13%) patients recurred following completion of adjuvant treatment (5 distant recurrences and 3 loco-regional recurrences). Recurrences were detected by patients, clinicians, CT and nodal US surveillance in 43%, 20%, 28% and 9% of cases, respectively. The majority of loco-regional recurrence was detected clinically (67%) rather than by radiologic surveillance (33%). Of the 30 loco-regional recurrences, 24 underwent surgical resection of the recurrence, 4 had subsequent systemic therapy without surgery, 1 had intra-tumoral injections and 1 had no treatment. Conclusions: Recurrences in Stage III melanoma occur early, often within a year, with higher rates of loco-regional rather than distant disease. Recurrence rates were lower in those who received adjuvant therapy, but the majority of recurrences were detected by patients or clinicians, including loco-regional recurrences in patients who had SLNB only despite surveillance nodal US.

Carotid Endarterectomy: Are We Meeting the Two Week Target?

2009 ◽  
Vol 54 (2) ◽  
pp. 27-29 ◽  
Author(s):  
RV Guest ◽  
JMJ Richards ◽  
SCA Fraser ◽  
RTA Chalmers
Keyword(s):  
Health Services ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Median Time ◽  
Retrospective Review ◽  
Stroke Prevention ◽  
Time Interval ◽  
Median Time Interval ◽  
Timing Of Onset ◽  
Prevention Benefit

Objective It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred. Methods This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis. Results The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days. Conclusion The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.

scholarly journals Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

2018 ◽  
Vol 146 (5) ◽  
pp. 594-599 ◽  
Author(s):  
I. A. Turiac ◽  
F. Fortunato ◽  
M. G. Cappelli ◽  
A. Morea ◽  
M. Chironna ◽  
...  
Keyword(s):  
Laboratory Investigation ◽  
Median Time ◽  
Surveillance System ◽  
Case Reports ◽  
Quality Data ◽  
Time Interval ◽  
System Sensitivity ◽  
Apulia Region ◽  
Median Time Interval ◽  
Capture Recapture

AbstractThis study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Larynx preservation with combined chemotherapy and radiation therapy in advanced but resectable head and neck cancer.

1991 ◽  
Vol 9 (5) ◽  
pp. 850-859 ◽  
Author(s):  
D G Pfister ◽  
E Strong ◽  
L Harrison ◽  
I E Haines ◽  
D A Pfister ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Radiation Therapy ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Neck Dissection ◽  
Combined Chemotherapy ◽  
Larynx Preservation ◽  
Preservation Rate ◽  
Disease Free

Forty patients with advanced, resectable squamous cell carcinoma of the larynx, oropharynx, or hypopharynx whose surgery would have required total laryngectomy (TL), were treated with one to three cycles of cisplatin-based chemotherapy before local therapy with the goal of larynx preservation. Clinical complete responses (CRs) or partial responses (PRs) to chemotherapy were seen in 26 of 40 patients (65%). Three patients with primary-site disease unresponsive to chemotherapy underwent resection of the primary lesion and neck dissection followed by radiation therapy (RT). Thirty-seven patients were referred after chemotherapy for RT +/- neck dissection. Thirty-one of 40 patient (78%) were rendered disease-free (no evidence of disease [NED]). With a median follow-up of 49 months (range, 31 to 76), the overall actuarial survival rate for the group was 58% at 2 years and 33% at 5 years. The failure-free survival rate was 42% and 33% at 2 and 5 years, respectively. Seven patients refused recommended TL throughout their course. This may have adversely affected survival results. A greater proportion of patients who achieved a CR or PR to chemotherapy remained disease-free compared with those who achieved less than a PR (P less than .001). Sixteen patients relapsed, 10 with locoregional disease. Six patients underwent TL, either for initial induction failure or at relapse, for an actual larynx-preservation rate of 34 of 40 patients (85%). If the seven patients who refused TL are included, the anticipated preservation rate is 27 of 40 patients (68%). Larynx preservation with combined chemotherapy and radiation is feasible and effective in patients with advanced, resectable squamous cell carcinoma of the head and neck (SCHN). This treatment approach requires a motivated patient, careful patient monitoring, and close interdisciplinary cooperation among oncologists.

The implications of treatment delays in adjuvant therapy for cholangiocarcinoma patients.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 291-291
Author(s):  
Matthew Parsons ◽  
Shane Lloyd ◽  
Skyler B Johnson ◽  
Courtney L. Scaife ◽  
Ignacio Garrido-Laguna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Study Cohort ◽  
Time Points ◽  
Factors Associated ◽  
Post Surgery ◽  
Significant Difference ◽  
Doubly Robust Estimation ◽  
The Impact

291 Background: To understand the factors associated with timing of adjuvant therapy in the management of intrahepatic and extrahepatic cholangiocarcinoma and the impact of delays on overall survival (OS). Methods: Data from the NCDB for patients with pathologically proven non-metastatic adenocarcinoma of the bile ducts from 2004 to 2014 were pooled and screened. Patients were included only if they underwent surgery and adjuvant chemotherapy (CMT) and/or radiotherapy (RT). Patients who underwent neoadjuvant therapy or received CMT or RT with palliative intent were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients who had initiation of adjuvant therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: In total, 7,422 patients in our analysis underwent adjuvant treatment. This represented 43% of the study cohort of 17,123 patients. Of the patients who underwent adjuvant treatment, 3,956 (53%) initiated adjuvant therapy by two months, 6,234 (84%) by 3 months and 6,987 (94%) by four months. High-grade disease, macroscopically positive margins, tumors larger than five centimeters, and unknown LVSI status, were associated with earlier initiation of adjuvant treatment at two months or earlier. Patients who received early adjuvant therapy were also more likely to be treated with a combination of CMT and RT. Factors associated with delay of adjuvant therapy beyond three months post-surgery included Charlson scores of one or greater and Hispanic race. After propensity score weighting, there was no survival difference between groups when comparing initiation of adjuvant therapy before or after two, three or four month time points Conclusions: We identified a number of patient characteristics related to the timing of initiating adjuvant therapy in patients with biliary cancers. There were no significant difference in OS associated with delaying adjuvant therapy beyond two, three or four month time-points. Our findings are relevant in the era of COVID-19 when minimizing patient exposure to health-care settings during a pandemic may need to be considered when deciding on the timing of adjuvant therapy. If a delay is necessary, our results suggest that there is no survival detriment to initiating adjuvant therapy beyond three or four months after surgery for biliary cancers.

Head and neck squamous cell carcinoma: Better to be young

2000 ◽  
Vol 122 (2) ◽  
pp. 253-258 ◽  
Author(s):  
Peter D. Lacy ◽  
Jay F. Piccirillo ◽  
Michael G. Merritt ◽  
Maria R. Zequeira
Keyword(s):  
Squamous Cell Carcinoma ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Young Patients ◽  
Neck Squamous Cell Carcinoma ◽  
Middle Aged ◽  
Old Patients ◽  
The Impact

Most head and neck squamous cell carcinoma patients are elderly, with few younger than 40 years. Controversy exists in the literature regarding outcomes for younger patients. The goal of this research project was to compare baseline features and outcomes for young patients (≤40 years), middle-aged patients (41–64 years), and old patients (≥65 years). To investigate the relationship between age and important presenting features and outcomes, 1160 recently diagnosed patients first treated at Washington University between 1980 and 1991 were identified from an existing database. Full 5-year survival information was available for 1030 patients (89%). Overall, the 5-year survival rate was 46% (478/1030); young patients (65%, 26/40) had a significantly better survival rate than middle-aged (52%, 292/566) or old patients (38%, 160/424) (χ2 = 24.5; P = 0.001). Survival was also related to smoking, comorbidity, primary site, TNM stage, and nodal disease. Age remained a significant factor even after we controlled for these other factors. Young patients developed fewer recurrent and new primary tumors. We conclude that young patients have a much better overall prognosis than older patients. The reasons for this difference are unclear, but it appears that the impact of age goes beyond an actuarial effect.

scholarly journals Impact of Multidisciplinary Team Management on the Survival Rate of Head and Neck Cancer Patients: A Cohort Study Meta-analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Changyi Shang ◽  
Linfei Feng ◽  
Ying Gu ◽  
Houlin Hong ◽  
Lilin Hong ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Survival Rate ◽  
Cohort Studies ◽  
Head And Neck ◽  
Neck Cancer ◽  
Multidisciplinary Team ◽  
Meta Analysis ◽  
Survival Rates ◽  
Team Management ◽  
The Impact

Background: Head and neck cancer (HNC) is one of the more common malignant tumors that threaten human health worldwide. Multidisciplinary team management (MDTM) in HNC treatment has been introduced in the past several decades to improve patient survival rates. This study reviewed the impact of MDTM on survival rates in patients with HNC compared to conventional treatment methods.Methods: Only cohort studies were identified for this meta-analysis that included an exposure group that utilized MDTM and a control group. Heterogeneity and sensitivity also were assessed. Survival rate data for HNC patients were analyzed using RevMan 5.2 software.Results: Five cohort studies (n = 39,070) that examined survival rates among HNC patients were included. Hazard ratios (HR) were calculated using the random effect model. The results revealed that exposure groups treated using MDTM exhibited a higher survival rate [HR = 0.84, 95% CI (0.76–0.92), P = 0.0004] with moderate heterogeneity (I2 = 68%, p = 0.01). For two studies that examined the effect of MDTM on the survival rate for patients specifically with stage IV HNC, MDTM did not produce any statistically significant improvement in survival rates [HR = 0.81, 95% CI (0.59–1.10), p = 0.18].Conclusions: The application of MDTM based on conventional surgery, radiotherapy, and chemotherapy improved the overall survival rate of patients with HNC. Future research should examine the efficacy of MDTM in patients with cancer at different stages.

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