Safety of Radiosurgery Applied to Conditions with Abnormal Tumor Suppressor Genes

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 860-864 ◽  
Author(s):  
Jeremy Rowe ◽  
Alison Grainger ◽  
Lee Walton ◽  
Matthias Radatz ◽  
Andras Kemeny
Keyword(s):  
Cohort Study ◽  
Tumor Suppressor Genes ◽  
Retrospective Cohort ◽  
Treatment Options ◽  
The Other ◽  
Von Hippel Lindau ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
Von Hippel Lindau Disease

Abstract OBJECTIVE To assess the risk of radiosurgery inducing malignancy in neurofibromatosis-2 (NF2) and von Hippel-Lindau disease. METHODS A retrospective cohort study of 118 NF2 and 19 von Hippel-Lindau disease patients, totalling 906 and 62 patient-years of follow-up data, respectively. RESULTS Two cases of intracranial malignancy were identified, both of which occurred in NF2 patients. One of these was thought to have arisen before the radiosurgery; the other was a glioblastoma diagnosed 3 years after radiosurgery. CONCLUSION Because gliomas may occur in as many as 4% of NF2 patients, this may not represent an increased risk. We continue to offer radiosurgery treatment to selected NF2 and von Hippel-Lindau disease patients and consider that the late risk of malignancy arising after irradiation must be put in the context of the condition being treated, the treatment options available to these individuals, and their life expectancy.

Progression of castrate-resistant (CR) disease in nonmetastatic (M0) prostate cancer (PC) patients: A retrospective cohort study using data from the Henry Ford Health System (HFHS).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15147-e15147
Author(s):  
Jennifer Beebe-Dimmer ◽  
Karynsa Cetin ◽  
Cecilia Yee ◽  
Lois Lamerato ◽  
Scott Stryker ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Specific Antigen ◽  
Population Based ◽  
Entire Cohort ◽  
Increased Risk ◽  
Diverse Patient Population

e15147 Background: Androgen deprivation therapy (ADT) is the cornerstone treatment of advanced PC, but is frequently used in the M0 setting. After a variable period of hormone-sensitivity, most patients develop CR disease (rising prostate-specific antigen [PSA] despite ongoing ADT). These men are at increased risk of developing bone metastases (BMT), particularly in those with higher serum PSA and shorter PSA doubling time (DT). The epidemiology and natural history of M0 CRPC has not been well-studied in a population-based setting. Methods: A retrospective cohort study was conducted using HFHS administrative data and included 691 men diagnosed with M0 PC between 1996 and 2005, who received ADT, with serial PSA measurements to determine CR. Patient records through 12/31/2008 were reviewed for outcomes of interest. CRPC was defined as 2 consecutive PSA rises, with “high risk” defined as PSA ≥8 ng/mL or PSA DT ≤10 months (mos) after the development of CRPC (Smith MR et al. Lancet 379:39-46, 2012). The risk of BMT was estimated for the entire cohort and for the CRPC and high-risk CRPC subsets. Results: Of the 691 patients included in the cohort (median age: 73 years, 48% African American), 98% received only GnRH agonists and 2% had orchiectomy. Median follow-up for the entire cohort after ADT initiation was 49 mos (IQR=45). 101 patients (15%) met criteria for CRPC during follow-up, with a median of 18 mos on active ADT prior to CRPC development (IQR=14). Of CRPC patients, 85% met criteria for high-risk (of those, 16% had PSA ≥8 ng/mL, 12% had PSA DT ≤10 mos, and 72% had both). Among all patients, 12% (n=82) developed BMT during follow-up, with 42% (n=36) of the high-risk CRPC subset developing BMT. Median time from high-risk CRPC to BMT was 9 mos (IQR=17). Conclusions: The HFHS resource allowed for our investigation of PSA characteristics corresponding to disease progression in a racially diverse patient population. A substantial proportion of M0 PC patients on ADT will eventually develop CR disease. Once a patient has CRPC, the risk of BMT is relatively high.

Metastases to hemangioblastomas in von Hippel–Lindau disease

2006 ◽  
Vol 105 (2) ◽  
pp. 256-263 ◽  
Author(s):  
S. Taylor Jarrell ◽  
Alexander O. Vortmeyer ◽  
W. Marston Linehan ◽  
Edward H. Oldfield ◽  
Russell R. Lonser
Keyword(s):  
Pancreatic Neuroendocrine Tumor ◽  
Von Hippel Lindau ◽  
Increased Risk ◽  
Age At Surgery ◽  
Von Hippel Lindau Disease ◽  
The Central Nervous System ◽  
Histological Characteristics ◽  
Tumor Metastases ◽  
Vhl Disease

Object Patients with hereditary cancer syndromes may be at increased risk for the development of tumor-to-tumor metastases. To gain insight into the biological nature of these lesions in the central nervous system (CNS), to determine their prevalence in a familial neoplasia syndrome, and to better define their management, the authors retrospectively examined a series of cases in which metastatic lesions developed within hemangioblastomas in patients with von Hippel–Lindau (VHL) disease. Methods The study included all cases of VHL disease in which patients underwent resection of a CNS hemangioblastoma that contained a metastasis or were found at autopsy to have a metastasis to a hemangioblastoma between January 2002 and December 2005 at the National Institute of Neurological Disorders and Stroke (NINDS). Clinical, histopathological, imaging, and surgical and/or autopsy findings were analyzed. Metastasis to a CNS hemangioblastoma was found in six resected tumors (8% of all hemangioblastomas resected from patients with VHL disease at the NINDS during the study period) from six patients (five women, one man; mean age at surgery 42.5 years). The primary site of metastatic disease was the kidney in five patients (renal cell carcinoma) and the pancreas in one (a pancreatic neuroendocrine tumor). Only one patient had systemic metastases at the time of resection of the hemangioblastoma containing the metastasis. Neurologically, all patients had remained at baseline or were improved at last clinical follow-up examination (mean follow-up duration 16.5 months, range 3–40 months). In all cases, postoperative imaging revealed that the hemangioblastoma resection was complete, and there was no evidence of recurrence in any of the patients at the last follow up. Two patients (including one who was also in the surgical group) were found at autopsy to have CNS metastases exclusively to spinal hemangioblastomas. Conclusions Hemangioblastomas are an early and preferred site for metastasis in VHL disease. Emerging histopathological techniques may lead to recognition of an increasing number of cases of tumor-to-hemangioblastoma metastasis. Management of cases involving tumor-to-hemangioblastoma metastases in VHL disease should be based on the histological characteristics of the primary tumor, extent of the primary disease, and completeness of the resection.

scholarly journals Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032930
Author(s):  
Annemarie Schop ◽  
Karlijn Stouten ◽  
Jurgen Riedl ◽  
Ron van Houten ◽  
Joost van Rosmalen ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Iron Deficiency ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Iron Deficiency Anaemia ◽  
Newly Diagnosed ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectivesTo describe all iron deficiency anaemia (IDA)–related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival.Design and settingRetrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands.ParticipantsMen and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously).MethodFrom February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis.Results587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95% CI 0.09 to 1.02).ConclusionEven with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

scholarly journals Mortality from Parkinson’s disease and other causes among a workforce manufacturing paraquat: an updated retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
John Andrew Tomenson ◽  
Clive Campbell
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Causes Of Death ◽  
Death Certificates ◽  
Female Workers ◽  
Increased Risk

Abstract Background Epidemiological studies of the association between Parkinson’s disease (PD) and paraquat (PQ) exposure have given inconsistent findings. The aim of the study was to update information on the risk of PD and mortality from major causes of death among a UK workforce who manufactured PQ by extending the follow-up by seven and a half years. Methods This retrospective cohort study included all employees who had ever worked on any of the four plants at Widnes, UK where PQ was manufactured between 1961 and 1995. The 926 male and 42 female workers were followed through 31 December 2017. Mortalities for males were compared with national and local rates, including rates for PD as a mentioned cause of death. Results A total of 394 male and 21 female workers had died by end of follow-up. Four death certificates of male workers mentioned PD, including two deaths that were due to PD. At least 6 death certificates of male employees would have been expected to have mentioned PD (SMR = 0.67; 95% CI 0.18–1.72). Reduced mortalities compared with local rates were found for major causes of death. Conclusions The study provided no evidence of an increased risk of PD, or increased mortalities from other causes among PQ production workers whose exposure to PQ on a daily basis was at least comparable to that of a PQ sprayer or mixer/loader.

RISK OF MALIGNANCY AFTER GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2007 ◽  
Vol 60 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Jeremy Rowe ◽  
Alison Grainger ◽  
Lee Walton ◽  
Paul Silcocks ◽  
Matthias Radatz ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cancer Registries ◽  
Benign Tumors ◽  
Data Set ◽  
National Mortality ◽  
Increased Risk ◽  
Patient Database ◽  
Risk Of Malignancy ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract OBJECTIVE To assess the risk of radiosurgery to cause malignant transformation in benign tumors or to induce new malignancies. METHODS A retrospective cohort study comparing the Sheffield, England, radiosurgery patient database with national mortality and cancer registries. This data set comprises approximately 5000 patients and 30,000 patient-years of follow-up, with more than 1200 patients having a follow-up period longer than 10 years. RESULTS In this material, a single new astrocytoma was diagnosed, whereas, based on national incidence figures, 2.47 cases would have been predicted. CONCLUSION No increased risk of malignancy was detected in this series, supporting the safety of radiosurgery. Pragmatically, in advising patients, the risks of malignancy would seem small, particularly if such risks are considered in the context of the other risks faced by patients with intracranial pathologies requiring radiosurgical treatments.

scholarly journals Endometrial Cancer Incidence in Endometriosis and Adenomyosis

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4592
Author(s):  
Marjolein Hermens ◽  
Anne M. van Altena ◽  
Iris Velthuis ◽  
Danielle C. M. van de Laar ◽  
Johan Bulten ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Endometrial Cancer ◽  
Cohort Study ◽  
Cancer Risk ◽  
Retrospective Cohort ◽  
Population Based ◽  
First Year ◽  
Endometrial Cancer Risk ◽  
Increased Risk

Women with histologically proven endometriosis/adenomyosis have an increased risk of ovarian cancer. Small studies show conflicting results on the endometrial cancer risk in women with endometriosis/adenomyosis. Therefore, we assessed the incidence of endometrial cancer in women with histologically proven endometriosis or adenomyosis. We performed a population-based retrospective cohort study of 129,862 women with histologically proven endometriosis/adenomyosis, matched with 132,700 women with a nevus selected from the Dutch pathology registry between 1990 and 2015. Histology results for endometrial cancer were retrieved. Crude and age-adjusted odds ratios for endometrial cancer were estimated. In the endometriosis/adenomyosis group, 1827 (1.4%) women had a histological report on endometrial cancer, and in the nevus group, 771 (0.6%) women. The age-adjusted OR for endometrial cancer was 2.58 (95%CI 2.37–2.81). After excluding the first year of follow-up, the age-adjusted OR was 0.76 (95%CI 0.63–0.92), indicating that endometrial cancer is most often found at time of histological diagnosis of endometriosis/adenomyosis. In around 20% of the endometrial cancer cases, the endometrial cancer was not recognized until after hysterectomy. Of these women, 35% had no prior (micro)curettage or biopsy. This study shows an increased incidence of endometrial cancer in women with histologically proven endometriosis and adenomyosis.

scholarly journals Treatment of Pityriasis Rubra Pilaris with Daily Low-Dose Methotrexate: A Retrospective Cohort Study

2021 ◽  
Vol 5 (4) ◽  
pp. 353-358
Author(s):  
Lauren G Yi ◽  
Benjamin A Tran ◽  
R Hal Flowers ◽  
Kenneth E Greer ◽  
Darren J Guffey
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Low Dose ◽  
Treatment Options ◽  
Complete Response ◽  
Pityriasis Rubra Pilaris ◽  
Dose Methotrexate ◽  
Mean Time

Background: Pityriasis rubra pilaris (PRP) is a rare disease that is difficult to manage. Treatment options include corticosteroids, immunomodulatory drugs, and biologics. Available literature has primarily described the use of weekly dosing of methotrexate, but there is limited data investigating the effectiveness of daily low-dose methotrexate in PRP treatment. Methods: A retrospective cohort study was conducted from September 2010 to December 2019 to determine the effectiveness of daily low-dose methotrexate in treating PRP. Results: The average duration of follow-up was 13.5 months. 14 patients were treated with oral daily low-dose methotrexate. 13 patients (92.9%) showed improvement on oral daily low-dose methotrexate. Mean time to clinical response was 5.9 weeks. In seven patients (50%), complete response on methotrexate monotherapy occurred within an average of 11.9 months. 12 patients (85.7%) developed asymptomatic transaminitis that resolved in most patients (66.7%) after dose reduction. Conclusions: In this study, daily low-dose methotrexate was an effective treatment of PRP and may be considered in patients unresponsive to weekly dosing. Due to the high incidence of transaminitis, the authors recommend frequent lab monitoring and screening for risk factors. Further studies are warranted to elucidate the efficacy of daily low-dose methotrexate in the management of PRP.

scholarly journals Trends in cardiovascular disease in Scottish military veterans: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044465
Author(s):  
Beverly P Bergman ◽  
Daniel F Mackay ◽  
Jill P Pell
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Military Veterans ◽  
Military Health ◽  
Increased Risk ◽  
The Difference

ObjectivesTo examine the risk of cardiovascular disease (CVD) in Scottish military veterans in comparison with people who had never served in long-term follow-up to 2017, and to compare the findings with our earlier study to 2012 to assess trends.DesignRetrospective cohort study with up to 37 years follow-up.SettingPseudo-anonymised extract of computerised Scottish National Health Service records and national vital records.Participants78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence.Outcome measuresRisk of first occurrence of acute myocardial infarction, peripheral arterial disease and stroke in veterans compared with non-veterans, overall and by sex and birth cohort.ResultsA first episode of CVD was recorded in 5.7% of veterans and 4.8% of non-veterans overall, Cox proportional HR 1.16, 95% CIs 1.12 to 1.20, p=0.001. The difference was only significant for men, and for veterans born before 1960, and was highest in veterans with the shortest service. In all categories, the difference in risk was less than at the end of 2012.ConclusionsThe excess burden of CVD in veterans which was evident at the end of 2012 has reduced in the following 5 years from 23% to 16% overall. The increased risk continues to affect only those veterans born prior to 1960, suggesting that improvements in military health promotion since 1978, when veterans born from 1960 joined the armed forces, have had an important and ongoing beneficial effect on the long-term health of veterans.

scholarly journals The Association between Migraine and Abdominal Aortic Aneurysms: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4389
Author(s):  
Jou-Yu Lin ◽  
Che-Se Tung ◽  
Jen-Chun Wang ◽  
Wu-Chien Chien ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Molecular Mechanisms ◽  
Cumulative Risk ◽  
Population Based ◽  
Aortic Aneurysms ◽  
Research Database ◽  
Abdominal Aortic ◽  
Increased Risk

Previous studies have indicated that patients with migraine have a higher prevalence of risk factors known to be associated with cardiovascular diseases. There are also shared epidemiology and molecular mechanisms between migraine and abdominal aortic aneurysm (AAA). We hypothesized that patients with migraine could have an increased risk of AAA. To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between migraine and AAA. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan. The assessed study outcome was the cumulative incidence of AAA in patients with migraine during a 15-year follow-up period. Among the 1,936,512 patients from the NHIRD, 53,668 (2.77%) patients were identified as having been diagnosed with migraine. The patients with migraine had a significantly higher cumulative risk of 3.558 of developing an AAA 5 years after the index date compared with the patients without migraine. At the end of the 15-year follow-up period, a significantly higher incidence of AAA (0.98%) was observed in the patients with migraine than in those without migraine (0.24%). We revealed an association between the development of migraine and AAA.

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