scholarly journals The impact of curative treatment on hyperglycemia in patients with Cushing syndrome

2021 ◽  
Author(s):  
Justine Herndon ◽  
Ravinder Jeet Kaur ◽  
Mark Romportl ◽  
Emily Smith ◽  
Amy Koenigs ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Cushing Syndrome ◽  
Insulin Dose ◽  
Close Monitoring ◽  
Oral Medications ◽  
Daily Insulin Dose ◽  
Appropriate Therapy ◽  
Therapy Modification ◽  
The Impact

Abstract Context Hyperglycemia is a common complication of Cushing syndrome (CS). Objective We aimed to determine the impact of curative procedure on hyperglycemia and its management in patients with CS. Design Retrospective longitudinal cohort study, 2000-2019. Setting Referral center. Patients Adults with endogenous CS and hyperglycemia. Main outcome measure Hemoglobin A1c (HbA1c), intensity of hyperglycemia therapy, improvement of hyperglycemia. Results In 174 patients with CS (pituitary in 106, ectopic in 25, adrenal in 43), baseline median HbA1c was 6.9% (range 4.9-13.1), with 41 (24%) patients not on any therapy for hyperglycemia, 93 (52%) on oral medications, and 64 (37%) on insulin (median daily units of 58, range 10-360). Following CS remission, at the end of follow up (median 10.5 months), 37 (21%) patients demonstrated resolution of hyperglycemia, 82 (47%) demonstrated improvement, and 55 (32%) had no change or worsening in hyperglycemia. At the end of follow up, HbA1c decreased by 0.84% (p < 0.0001) and daily insulin dose decreased by a mean of 30 units, p < 0.0001. Biochemical hypercortisolism severity score (severe vs moderate/mild: Odds ratio (OR) of 2.4 (95%CI of 1.1-4.9)), and CS subtype (nonadrenal vs adrenal: OR of 2.9 (95%CI 1.3-6.4)), but not type of hyperglycemia (diabetes vs prediabetes: OR of 2.1 (0.9-4.9)) were associated with hyperglycemia improvement at the end of follow up. Conclusion Two thirds of patients with CS and hyperglycemia demonstrate resolution or improvement of hyperglycemia after a curative procedure. Close monitoring during CS recovery is needed to assure appropriate therapy modification.

scholarly journals The United Kingdom’s first NHS EndoBarrier service for long-standing poorly controlled type 2 diabetes and obesity: outcomes one year after EndoBarrier removal

2021 ◽  
Author(s):  
Robert E J Ryder ◽  
Mahi Yadagiri ◽  
Wyn Burbridge ◽  
Susan P Irwin ◽  
Hardeep Gandhi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Dose ◽  
Severe Depression ◽  
Sustained Improvement ◽  
White Ethnicity ◽  
Daily Insulin Dose ◽  
One Year ◽  
Diabetes And Obesity

Aims: EndoBarrier is a 60 cm duodenal–jejunal bypass liner endoscopically implanted for up to one year. It mimics the bypass part of Roux-en-Y bariatric surgery and reduces weight and HbA1c while it is in situ. We aimed to assess the extent to which these improvements are sustained in people with diabetes in the year following removal.Methods: Between October 2014 and November 2017 we implanted 62 EndoBarriers in an NHS service with all removed by November 2018. Outcomes were monitored in a registry.Results: By November 2019, 46/62 (72%) (mean±SD age 51.5±7.7 years, 52% male, 54.3% white ethnicity, median (IQR) diabetes duration 14.5 (8–20) years, 67.4% insulin-treated and mean±SD body mass index (BMI) 41.6±7.1 kg/m2) had attended and 16/62 (28%) did not attend their one-year post-EndoBarrier follow-up appointment. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 21.1±19.6 mmol/mol from 77.1±20.0 to 56.0±11.2 mmol/mol (p<0.001) (by 1.9±1.8% from 9.2±1.8% to 7.3±1.0% (p<0.001)), weight fell by 17.2±8.8 kg from 121.9±29.4 kg to 104.7±30.1 kg (p<0.001), BMI fell from 41.6±7.5 to 35.5±7.5 kg/m2 (p<0.001), systolic blood pressure from 139.0±14.0 to 126.0±14.6 mmHg (p<0.001) and serum alanine aminotransferase from 30.0±16.9 to 18.8±11.0 U/L (p<0.001). Median (IQR) total daily insulin dose reduced from 104 (54–162) to 30 (0–62) units (n=31, p<0.001); 10/31 (32%) insulin-treated people with diabetes were able to discontinue insulin. One year post-EndoBarrier, 18/46 (39%) demonstrated fully sustained improvement, 18/46 (39%) partially sustained improvement and 10/46 (22%) reverted to baseline. Of those deteriorating, 9/10 (90%) had depression and/or bereavement; they also had less fall in weight and HbA1c during EndoBarrier treatment. In the 16/62 (28%) who did not attend follow-up, reasons for non-attendance were too far to travel (25%), need to take time off work (6.3%), severe depression (6.3%) and death (6.3%). In 56.3% of cases no reason was given.Conclusion: Our data demonstrate that EndoBarrier is highly effective in people with long-standing poorly controlled type 2 diabetes and obesity, with maintenance of significant improvement one year after removal in 78% of cases for whom data were available. As an endoscopic procedure it is relatively simple and non-invasive and it deserves further investigation.

scholarly journals Seven-day Fasting as a multimodal complex intervention for Adults with Type 1 Diabetes – Feasibility, Benefit and Safety in a Controlled Pilot Study

2020 ◽  
Author(s):  
Bettina Berger ◽  
Ekkehart Jenetzky ◽  
Diana Köblös ◽  
Rainer Stange ◽  
Andrea Baumann ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Insulin Dose ◽  
Daily Insulin Dose ◽  
The Metabolic Syndrome ◽  
Average Glucose

Abstract Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply may also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, benefit and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes with data acquisition toking place prior, post and four months after the intervention and daily during intervention. Results: 29 of 30 participants finished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L89 [± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. The was a decrease from before until the follow -up four month late of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average. Conclusions/Interpretation: This study demonstrates the feasibility, benefits and safety aspects of a 7-day fast in adults with type 1 diabetes.

scholarly journals Is Diabetic Ketoacidosis A Good Predictor Of 5-Year Metabolic Control in Children with Newly Diagnosed Type 1 Diabetes?

2021 ◽  
Author(s):  
Emilia Kowalczyk ◽  
Aneta Stypułkowska ◽  
Barbara Majewska ◽  
Małgorzata Domaradzka ◽  
Aleksandra Hoffmann ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Dose ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Daily Insulin Dose ◽  
Early Implementation ◽  
Modern Technologies

Abstract Purpose: The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up.Methods: The study included children treated due to newly diagnosed T1D complicated with DKA between 2010-2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS.Results: 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p=.413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII=-1.46,95%CI[-2.01 to -0.92],p<.001.Conclusions: The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.

Abstract P161: Relationship Between Clinical Availability of Hemoglobin A1c and Glucose Therapy Intensification in Patients With Diabetes Hospitalized for Acute Myocardial Infarction

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Joshua M Stolker ◽  
John A Spertus ◽  
Darren K McGuire ◽  
Silvio E Inzucchi ◽  
Saif S Rathore ◽  
...  
Keyword(s):  
Regression Models ◽  
Hemoglobin A1c ◽  
Clinical Care ◽  
Insulin Dose ◽  
Daily Insulin Dose ◽  
Patients With Diabetes ◽  
Acute Mi ◽  
Glucose Therapy ◽  
Multivariable Adjustment

BACKGROUND Hemoglobin A 1c (A1C) assessment is recommended for hospitalized patients (pts) with diabetes (DM). Whether in-hospital A1C levels are associated with glucose therapy intensification (GTI) after MI is unknown. METHODS TRIUMPH is a multicenter MI registry which enrolled 1343 pts with established DM between 2005-08. Of 1149 pts with DM and measured A1C, 886 (77%) were assessed as part of clinical care, and an additional 263 (23%) had A1C assessed in the research core laboratory (results unavailable to clinicians). GTI was defined as new or increased doses of antihyperglycemic agents, or increased daily insulin dose by ≥20% at discharge. Pts were divided into those with vs. without clinically available A1C and stratified by A1C subgroup (<7, 7-9, >9). Poisson regression models evaluated if clinically available A1C was independently associated with GTI. RESULTS Overall, 420 of 1149 pts (36%) with measured A1C had levels <7, 423 (37%) were between 7-9, and 306 (27%) were >9. GTI was prescribed in 367 pts (32%). Clinically available A1C was associated with more frequent GTI in pts with suboptimal (A1C 7-9) and poor (A1C >9) glycemic control, but not in those with adequate control (A1C <7; Figure ). After multivariable adjustment (including blood glucose), clinically available A1C was an independent predictor of GTI (RR 1.27, 95% CI 1.08-1.51). CONCLUSION Nearly two-thirds of pts with DM have suboptimal or poor long-term glucose control at the time of acute MI, and fewer than 50% of these pts are prescribed GTI at hospital discharge. Availability of A1C levels to clinicians may facilitate intensification of glucose therapy after MI in pts with inadequate long-term DM control.

scholarly journals Autonomous and Continuous Adaptation of a Bihormonal Bionic Pancreas in Adults and Adolescents With Type 1 Diabetes

2014 ◽  
Vol 99 (5) ◽  
pp. 1701-1711 ◽  
Author(s):  
Firas H. El-Khatib ◽  
Steven J. Russell ◽  
Kendra L. Magyar ◽  
Manasi Sinha ◽  
Katherine McKeon ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Controlled Trial ◽  
Insulin Dose ◽  
Total Daily Dose ◽  
Insulin Requirements ◽  
Daily Insulin Dose ◽  
And Shifts ◽  
The Impact

Context: A challenge for automated glycemic control in type 1 diabetes (T1D) is the large variation in insulin needs between individuals and within individuals at different times in their lives. Objectives: The objectives of the study was to test the ability of a third-generation bihormonal bionic pancreas algorithm, initialized with only subject weight; to adapt automatically to the different insulin needs of adults and adolescents; and to evaluate the impact of optional, automatically adaptive meal-priming boluses. Design: This was a randomized controlled trial. Setting: The study was conducted at an inpatient clinical research center. Patients: Twelve adults and 12 adolescents with T1D participated in the study. Interventions: Subjects in each age group were randomized to automated glycemic control for 48 hours with or without automatically adaptive meal-priming boluses. Main Outcome Measures: Mean plasma glucose (PG), time with PG less than 60 mg/dL, and insulin total daily dose were measured. Results: The 48-hour mean PG values with and without adaptive meal-priming boluses were 132 ± 9 vs 146 ± 9 mg/dL (P = .03) in adults and 162 ± 6 vs 175 ± 9 mg/dL (P = .01) in adolescents. Adaptive meal-priming boluses improved mean PG without increasing time spent with PG less than 60 mg/dL: 1.4% vs 2.3% (P = .6) in adults and 0.1% vs 0.1% (P = 1.0) in adolescents. Large increases in adaptive meal-priming boluses and shifts in the timing and size of automatic insulin doses occurred in adolescents. Much less adaptation occurred in adults. There was nearly a 4-fold variation in the total daily insulin dose across all cohorts (0.36–1.41 U/kg · d). Conclusions: A single control algorithm, initialized only with subject weight, can quickly adapt to regulate glycemia in patients with TID and highly variable insulin requirements.

scholarly journals Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus

2021 ◽  
Vol 9 (1) ◽  
pp. e001797
Author(s):  
Molly J Y Zhao ◽  
Julia C Prentice ◽  
David C Mohr ◽  
Paul R Conlin
Keyword(s):  
Diabetes Mellitus ◽  
Hemoglobin A1c ◽  
Severe Hypoglycemia ◽  
International Classification Of Diseases ◽  
Baseline Period ◽  
Veterans Health ◽  
Health Administration ◽  
Classification Of Diseases ◽  
The Impact

IntroductionTo study the impact of hemoglobin A1c (A1c) variability on the risk of hypoglycemia-related hospitalization (HRH) in veterans with diabetes mellitus.Research design and methods342 059 veterans with diabetes aged 65 years or older were identified for a retrospective cohort study. All participants had a 3-year baseline period from January 1, 2005 to December 31, 2016, during which they had at least four A1c tests. A1c variability measures included coefficient of variation (A1c CV), A1c SD, and adjusted A1c SD. HRH was identified during a 2-year follow-up period from Medicare and the Veterans Health Administration through validated algorithms of International Classification of Diseases (ICD)-9 and ICD-10 codes. Logistic regression modeling was used to evaluate the relationship between A1c variability and HRH risk while controlling for relevant clinical covariates.Results2871 patients had one or more HRH in the 2-year follow-up period. HRH risk increased with greater A1c variability, and this was consistent across A1c CV, A1c SD, and adjusted A1c SD. Average A1c levels were also independently associated with HRH, with levels <7.0% (53 mmol/mol) having lower risk and >9% (75 mmol/mol) with greater risk. The relationships between A1c variability remained significant after controlling for average A1c levels and prior HRH during the baseline period.ConclusionIncreasing A1c variability and elevated A1c levels are associated with a greater risk of HRH in older adults with diabetes. Clinicians should consider A1c variability when assessing patients for risk of severe hypoglycemia.

scholarly journals Seven-day Fasting as a multimodal complex interventionfor Adults with Type 1 Diabetes – Feasibility, Benefit and Safety in a Controlled Pilot StudyFeasibility of Fasting for Adults with Type 1 Diabetes 

2020 ◽  
Author(s):  
Bettina Berger ◽  
Ekkehart Jenetzky ◽  
Diana Köblös ◽  
Rainer Stange ◽  
Andrea Baumann ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Randomized Controlled ◽  
Daily Insulin Dose ◽  
The Metabolic Syndrome ◽  
Average Glucose

Abstract Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply might also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, benefit and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes. Data acquisition took place prior, post and four months after the intervention and daily during intervention. Results: 29 of 30 participants finished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L [89 ± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. There was a decrease from before until the follow-up four month later of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average. Conclusions/Interpretation: This study demonstrates the feasibility, benefits and safety aspects of a 7-day fast in adults with type 1 diabetes.

scholarly journals Evaluation of a Conservative Pharmacist-led U-500R Insulin Management Protocol in the Primary Care Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272097382
Author(s):  
Cyndi Dumont ◽  
Leah Fitzgerald ◽  
Connie A. Valdez
Keyword(s):  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Point Reduction ◽  
Daily Insulin Dose ◽  
Management Protocol ◽  
Daily Dose ◽  
The Impact ◽  
Total Daily Dosage

Objective The objective of this quality assurance study is to evaluate the impact of a conservative, pharmacist-led, U-500R insulin management protocol on diabetes control (A1c) and total daily dosage requirements between August 2016 and August 2018. Methods This was a retrospective chart review of adult patients, aged 18 to 79, with type 2 diabetes and managed with insulin, at 2 federally qualified healthcare clinics in Denver, Colorado. To determine if our conservative pharmacist-led U-500R insulin management protocol impacted efficacy and total daily dosage requirements when converting patients from U-100 to U-500R insulin, we compared the most effective dose of U-500R (defined as the total daily dose (TDD) of U-500R insulin at A1c goal or the lowest tolerated A1c) to the baseline A1c and TDD of U-100 insulin at time of conversion. Results Following conversion of U-100 to U-500R insulin, patients required an average of 21 fewer units of insulin with U-500R than U-100 and achieved an average A1c of 7.2% which reflected a reduction of 3.5 points from baseline. Five patients (62.5%) achieved A1c goal per ADA guidelines, and all patients achieved at least a 1.7 point reduction in A1c, with 1 patient achieving a 6.7 point reduction. Two patients (25%) were still in the process of U-500R titration at the time of data collection, and 1 patient (12.5%) did not achieve goal A1c while under pharmacy management at these clinics. Four of the five patients who achieved A1c goal did so with an overall reduction in total daily insulin dose (average of 57.5 units less than original U-100 dose) resulting in an average A1c decrease of 3.6 points.

scholarly journals Does Length of Relationship or Gender Predict Response to Behavioral Diabetes Intervention?

2017 ◽  
Vol 43 (2) ◽  
pp. 216-222
Author(s):  
Jonathan Sandberg ◽  
Jeremy B. Yorgason ◽  
Lawrence Fisher ◽  
Ruth S. Weinstock ◽  
Danielle Hessler ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Intervention Group ◽  
Secondary Analysis ◽  
Diabetes Intervention ◽  
Length Of Relationship ◽  
The Individual ◽  
The Impact ◽  
Couples Intervention

Purpose The purpose of the study was to determine, through secondary analysis, whether the length of a couple’s relationship and the participants’ gender are associated with glycemic response to a type 2 diabetes (T2D) behavioral couples-based intervention. Methods A randomized trial was conducted to test the impact of a couples-level, telephone-based behavioral intervention on hemoglobin A1C in patients with T2D. One hundred and four patients and partners participated in the couples intervention arm, and 94 individuals participated in the individual arm. A1C levels were measured at baseline and 1-year follow-up. Results Results of the regression analysis showed that for men with T2D (n = 35) in the couples intervention group, longer length of relationship was associated with lower A1C at 1-year follow-up, after controlling for baseline A1C, diabetes duration, and income. Length of relationship was not significantly related to follow-up glycemic measures for women or men with T2D in the individual intervention. Conclusions Study findings suggests that for men with T2D in a couples-based intervention, those in longer relationships may be more likely to benefit from the intervention. More research is needed to better understand factors that contribute to successful couples-based behavioral approaches to help adults with T2D improve their glycemic control.

A risk-based individualized follow-up after complete surgery as an effective procedure to reduce the relapse (R) impact in GIST patients (pts).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10552-10552
Author(s):  
Erica Palesandro ◽  
Danilo Galizia ◽  
Lorenzo D'Ambrosio ◽  
Paola Boccone ◽  
Sandra Aliberti ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Tumor Burden ◽  
Final Outcome ◽  
Kaplan Meier ◽  
Negative Prognostic Factor ◽  
Appropriate Therapy ◽  
Group 2 ◽  
The Impact ◽  
Group 1

10552 Background: FU care poses a burden on both pts and health system. FU aims to precociously identify recurrences, metastases or treatment-related adverse events so to undertake the appropriate therapy as soon as possible. Guidelines (NCCN, ESMO) admit lack of knowledge on optimal surveillance, but suggest FU based on experts’ opinion and risk stratification. Moreover, tumor burden (TB) is a well known negative prognostic factor (Van Glabbeke 2005). Therefore, low-TB at R might affect final outcome. To identify the impact, if any, of regular FU, we examined our prospectively collected database looking for Rs in which the early detection affected both clinical management and, likely, the outcome. Methods: 140 pts were stratified (AFIP classification). High risk (HR) pts had complete history + physical examination (H&P) and CT every 3 mos for 2 years, 4 mos in 3rd year, 6 mos in the 4th and 5th yrs, yearly thereafter; intermediate (IR), low (LR) and very low risk (VLR) pts had H&P + CT every 4 mos for 2 years, every 6 mos up to the 5th year, then yearly. Rs were divided in: low-TB + completely resectable R (Group 1) and high-TB + disseminated R (Group 2). The number of CT needed to detect (NND) one R and the incidence of early (<6 mos) R was calculated. Overall survival (OS) was estimated by Kaplan-Meier method. Results: In 73 male and 67 female, median age 63 (23-82), risk stratification was: HR 73, IR 31, LR 28, VLR 8. After a median FU of 63 mos we observed 58 Rs: 25 (43%) and 33 (57%) in group 2 and 1, respectively. Relapsed pts genotype was KIT Ex11 72%; Ex9 10%; Ex13 3%; wild-type 15%. Median time to R was 16 mos (1-120). 21 pts underwent surgical resection of their R. 16 pts remained free from progression for a median of 90 mos. We detected 15 (26%) early Rs. NND was 17 and 32 CT for HR and non-HR pts, respectively. Group 1 and 2 median estimated OS was 112 and 87 mos (p=.05), respectively. Conclusions: Though retrospective, this series shows that FU may detect low-TB Rs. In principle, this might affect pts final outcome and, therefore, justify this costly effort. Since it is difficult to foresee a prospective randomized trial, a confirmation of these data in a different series might increase their reliability.

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