Rectal Dose Is the Other Dosimetric Factor in Addition to Small Bowel for Prediction of Acute Diarrhea during Postoperative Whole-Pelvic Intensity-Modulated Radiotherapy in Gynecologic Patients

We studied the association of rectal dose with acute diarrhea in patients with gynecologic malignancies undergoing whole-pelvic (WP) intensity-modulated radiotherapy (IMRT). From June 2006 to April 2019, 108 patients with previous hysterectomy who underwent WP IMRT were enrolled in this cohort study. WP irradiation of 39.6–45 Gy/22–25 fractions was initially delivered to the patients. Common Terminology Criteria for Adverse Events (CTCAE) version 3 was used to evaluate acute diarrhea during radiotherapy. Small bowel volume at different levels of isodose curves (Vn%) and mean rectal dose (MRD) were measured for statistical analysis. The multivariate analysis showed that the MRD ≥ 32.75 Gy (p = 0.005) and small bowel volume of 100% prescribed (V100%) ≥ 60 mL (p = 0.008) were independent factors of Grade 2 or higher diarrhea. The cumulative incidence of Grade 2 or higher diarrhea at 39.6 Gy were 70.5%, 42.2%, and 15.0% (p < 0.001) in patients with both high (V100% ≥ 60 mL and MRD ≥ 32.75 Gy), either high, and both low volume-dose factors, respectively. Strict constraints for the rectum/small bowel or image-guided radiotherapy to reduce these doses are suggested.

Using the Risk Assessment Index to predict mortality and quality of life in breast and gynecologic cancer patients.

239 Background: Cancer patients vary considerably in health status making it challenging to evaluate the risk of complications from cancer treatment. To aid oncologists in identifying patients with highest risk for adverse outcomes, we investigated the Risk Assessment Index (RAI), a validated tool used to assess frailty in patients prior to elective surgery. We assessed whether the RAI could serve to predict mortality, hospital utilization, and quality of life in cancer patients. Methods: Participants were breast and gynecological cancer patients treated at UPMC Magee Women’s Cancer Center who completed the RAI between July 2016 and December 2017. Patients completed patient reported outcomes (PROs) during each visit including the Short Form (SF)-12, Edmonton Symptom Assessment, anxiety and depression screens, and MD Anderson Symptom Inventory (MDASI) and were analyzed up to 180 days from the RAI date. Mortality was assessed at 90, 180, and 365-day intervals, and hospital utilization was assessed within 90-days of RAI. Results: There were 1,764 unique breast and gynecological cancer patients. Significant correlations between the RAI and mortality were observed for both groups with frail patients having higher rates of mortality at each interval. Frailty was associated with higher rates of hospitalization compared to non-frail patients (31% vs 20%, p = 0.05 & 50% vs 34%, p = 0.02 for breast and gynecologic patients, respectively). Frailty correlated with fair/poor ratings on the SF-12 for breast and gynecologic patients (r = 0.13, p = 0.01; r = 0.37 p < 0.001, respectively). On the Edmonton, frailty correlated with lower ratings of well-being in breast cancer patients (r = 0.11, p = 0.012) and higher symptom burden in gynecological patients (r = 0.23, p = 0.01). No correlations were observed between the RAI and anxiety or depression. For gynecologic patients, there were significant correlations between the RAI and MDASI with frail patients having higher rates of pain, fatigue, appetite, diarrhea, and memory. Conclusions: We demonstrated that the RAI is correlated with mortality, self-reported quality of life, and hospitalizations in breast and gynecologic cancer patients. Using this tool to risk-stratify patients may help to guide shared decision-making discussions and provide appropriate treatment and/or supportive services for this vulnerable population.

Resumption of the Treatment for Non-COVID-19 Gynecologic Patients after Lifting Lockdown: Experiences from Wuhan

Background: To share our experiences of resumption of the treatment for gynecologic patients after lifting lockdown in a hotspot area of the Corona Virus Disease 2019 (COVID-19)pandemic.Methods: The triage process used to resume the medical activities for gynecologic patients at the Wuhan Union Hospital after a 76-day lockdown of the city is described and its effectiveness to avoid COVID-19 nosocomial transmission is shown.Results:The non-emergency patients are pre-triaged by contact history and body temperature at outpatient clinic and negative COVID-19 screening tests are required for an admissionin the buffering rooms at the gynecologic department. The buffering lasts for at least three days for symptom monitoring and a second round of COVID-19 tests before they can be transferred to the regular gynecologic wards. For patients who need emergency surgery, the first screening should be completed at the quarantine wards after the surgery, followed by buffering at the gynecologic department. We received 19298 outpatient visits, admitted 326 patients, and performed 223 operations in the first two months after the lockdown was lifted, and no single COVID-19 case occurred in the hospitalized patients while the proportion of potentially high-risk patients with cancer and severe anemia were increased in comparison with the same period in 2019 and the latest two months before the lockdown.Conclusions:We provide an effective triage system with buffering at two levels to guarantee safe and timely treatment fornon-COVID-19 gynecologic patients in a post-lockdown phase.

Significance of Expiratory Muscle Strength in Gynecologic Patients after Spinal Anesthesia

Background: The spinal block has become a favorable technique for gynecologic surgery. However, the level of sympathetic blockade results in weak diaphragm and respiratory muscles as well as cough impairment. Investigators were curious to assess patients’ respiratory functions after spinal anesthesia. Materials and Methods: One hundred forty-five gynecologic patients undergoing elective, exploratory laparotomy with spinal anesthesia were included. The blowing practice of a Mini Wright Peak Flow Meter was performed until patients became comfortable with it. A given patient blew the device three times, and the best value was chosen to assess peak expiratory flow rates (PEFRs): prior to surgery (P1), after the spinal block (P2), and in the recovery room (P3). Results: At the thoracic blockade level as T was 4 or less and T was greater than 4, PEFR at P1, P2 and P3 were 285.9±5.9, 222.3±4.9, and 216.4±6.4 mL, and 302.8±7.7, 224.9±6.4, and 203.4±8.4 mL, respectively. The PEFRs showed no significant differences among the levels of blockade at the ward (p=0.082), the operating theater (p=0.744), and the recovery room (p=0.211). Though P3 seemed to fall, there was no marked difference between P2 and P3 (p=0.224). However, either P2 or P3 appeared to decrease sharply (p<0.001) in comparison with P1. Conclusion: A Mini Wright Peak Flow Meter can be used as a bedside device to measure PEFRs. The substantial decrease of PEFR was related to the level of sympathetic blockade after spinal anesthesia. Keywords: Anesthesia, Spinal block, Peak expiratory flow rate, Gynecology

Resumption of the Treatment for Non-COVID-19 Gynecologic Patients after Lifting Lock down: Experiences from Wuhan

Background: To share our experiences of resumption of the treatment for gynecologic patients after lifting lockdown in a hotspot area of the Corona Virus Disease 2019 (COVID-19)pandemic.Methods: The triage process used to resume the medical activities for gynecologic patients at the Wuhan Union Hospital after a 76-day lockdown of the city is described and its effectiveness to avoid COVID-19 nosocomial transmission is shown.Results:The non-emergency patients are pre-triaged by contact history and body temperature at outpatient clinic and negative COVID-19 screening tests are required for an admissionin the buffering rooms at the gynecologic department. The buffering lastsfor at least three days for symptom monitoring and a second round of COVID-19 tests before they can be transferred to the regular gynecologic wards. For patients who need emergency surgery, the first screening should be completed at the quarantine wards after the surgery, followed by buffering at the gynecologic department. We received 19298 outpatient visits, admitted 326 patients, and performed 223 operations in the first two months after the lockdown was lifted, andno single COVID-19 case occurredin the hospitalized patients while the proportion of potentially high-risk patients with cancer and severe anemia were increased in comparison with the same period in 2019 and the latest two months before the lockdown.Conclusions:We provide an effective triage system with buffering at two levels to guarantee safe and timely treatment for non-COVID-19 gynecologic patients in a post-lockdown phase.