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Pelvic Radiotherapy (pelvic + radiotherapy)
Selected AbstractsAttitudes to evidence-based practice in urology: Results of a surveyANZ JOURNAL OF SURGERY, Issue 5 2001Alan M. F. Stapleton Background: The advantages of promoting evidence-based care through implementation of clinical guidelines are well established. Clinical practice guidelines have been developed for lower urinary tract symptoms (LUTS) and prostate cancer screening. Aspects of the delivery of care by urologists or specialist registrars relevant to the guidelines were assessed. Methods: A questionnaire was distributed at the 1999 meeting of the Urological Society of Australasia, which was attended by 187 Australasian and 33 foreign delegates. Questions addressed access to resources for evidence-based medicine; perceived need; preferred sources of information; and then presented four clinical scenarios. These were: (i) treatment recommendations in early stage prostate cancer; (ii) the same scenario if the respondent was the patient; (iii) treatment recommendations after radical prostatectomy when there was a positive resection margin; and (iv) clinical investigations for mild to moderate LUTS. Results: Of 220 possible responses, 132 were received, a response rate of 60%. Urologists overwhelmingly (100%) endorsed the need for access to evidence-based reviews, although 28% claimed such access was non-existent to poor. Clinical guidelines were the preferred source of evidence-based information. For early stage prostate cancer in a 55-year-old man, radical prostatectomy was recommended by 93.2% of respondents, but this dropped to 83% when the respondent was the patient (P < 0.05), and a wider range of treatments was recommended. Pelvic radiotherapy and hormone therapy were equally recommended for biochemical progression following radical prostatectomy where there was a positive surgical margin. Investigations for LUTS included serum prostate-specific antigen (PSA) testing (78.0%) and voided flow studies (77.3%). Conclusions: Urologists express a need for evidence-based practice resources, in particular clinical guidelines. Nevertheless their clinical approach is not necessarily consistent with existing guidelines, particularly for LUTS. An alteration in the recommendation when the respondent is the patient of interest and endorses the recommendation that patients with prostate cancer should be involved in treatment decisions. [source] Epidermoid anal cancer prognosis comparison among HIV+ and HIV, patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009L. ABRAMOWITZ Summary Background, Previous studies suggest a poor prognosis of epidermoid anal cancer in HIV+ patients. Aim, To investigate the long-term outcome of epidermoid anal cancer in HIV+ and HIV, patients in the highly active antiretroviral treatment (HAART) era. Methods, We included all patients with epidermoid anal cancer referred to six hospitals from 1998 to 2004. Results, In all, 151 patients (44 HIV+, 107 HIV,) were reviewed retrospectively for 27 (median of 16,44) months. HIV+ patients were male (100% vs. 27%, P < 0.001) and younger (45 vs. 62 years old, P < 0.001) than HIV, patients. No significant differences were observed in the tumour stage, pelvic radiotherapy dose or concomitant chemotherapy, according to the HIV status. After chemoradiotherapy, similar numbers of HIV+ and HIV, patients had grade III-IV toxicity. A complete response was obtained in 82% and 75% (N.S.) of cases, respectively. The disease-free survival rates were 77% and 67% (N.S.) and the overall survival rates were 85% and 84% (N.S.), respectively, after 3 years of follow-up. Duration of HIV infection, viral load and CD4 count had no effect on the survival rate of HIV+ patients with EAC. Conclusions, The clinical outcome of HIV+ patients with epidermoid anal cancer is similar to that of HIV, patients. Therefore, the same therapeutic guidelines should be applied to both populations. [source] Treatment of haemorrhagic radiation-induced proctopathy using small volume topical formalin instillationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2006S. N. CULLEN Summary Background Between 2 and 5% of patients undergoing pelvic radiotherapy develop chronic radiation proctopathy, occurring as a result of damage to the rectal mucosa during the treatment. Rectal bleeding of varying severity can occur as a consequence. There have been no formal trials of treatment for haemorrhagic radiation proctopathy and a variety of methods are currently used. Aim In a retrospective study of 20 patients treated at a single centre, we assessed the efficacy of small volume topical formalin instillation to control bleeding from radiation proctopathy. Method Patients were treated by a single operator using 20 mL of a 5% solution of formalin instilled into the rectum via a flexible sigmoidoscope for 3 min. Patients were followed up for an average of 22.7 months (range: 2,69). Results A single session of formalin treatment was effective in 13 of 20 (65%) patients and a further four (20%) patients responded to a second treatment. No complications of the treatment was identified. Conclusion Small volume formalin instillation therapy appears to be safe and effective in the context of haemorrhagic radiation proctopathy. The technique is simple, inexpensive, quick and requires no sedation. We suggest that it should be considered as a first line for patients presenting with this distressing condition. [source] Uterine papillary serous carcinoma: Patterns of failure and survivalAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Wei WANG Objective: To evaluate the outcome in patients with uterine papillary serous carcinoma (UPSC). Methods: A retrospective review of women treated for UPSC between 1995 and 2006 in Westmead Hospital, Sydney. The patients were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy and surgical staging. The majority of the patients had platinum-based adjuvant chemotherapy and radiotherapy. Sites of initial recurrence were documented. Overall survival (OS) and progression free survival (PFS) were estimated using Kaplan,Meier method. Univariate and multivariate analysis was performed using Cox regression analysis to test the effects of multiple prognostic factors on survival. Results: Two-year and five-year OS was 65% and 43%. The median OS was 39 months. Two-year and five-year PFS was 60% and 35%. Macroscopic residual disease at the completion of surgery was the only significant prognostic factor associated with worse OS on both univariate and multivariate analysis (P < 0.001). The median OS was only 11 months if patients had macroscopic residual disease, and all patients died within 18 months despite adjuvant therapies. Twenty-one patients relapsed. The site(s) of initial recurrence were: vagina (five patients), pelvic lymph nodes (four patients), abdomen (11 patients), para-aortic lymph nodes (six patients), inguinal lymph nodes (two patients) and distant metastases in seven patients. Only one of 16 patients who received vaginal brachytherapy failed in the vagina, but three of seven patients who received external beam pelvic radiotherapy failed in the vagina. Conclusion: We recommend optimal cytoreduction surgery with the aim of leaving no macroscopic disease at the end of the operation. Vaginal brachytherapy should be considered as a component of adjuvant radiotherapy. Abdominal failure was the commonest mode of failure in our cohort of patients. [source] TEMS: an alternative method for the repair of benign recto-vaginal fistulaeCOLORECTAL DISEASE, Issue 6 2008R. J. Darwood Abstract Indications, The repair of high recto-vaginal fistula can be challenging since access may be limited via the endo-anal approach yet the alternative trans-abdominal route carries significant morbidity. We report the use of TEMS to repair a recto-vaginal fistula following anterior resection and pelvic radiotherapy. Method, The patient was placed prone and a 25cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. Comparison with other techniques, TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo-anal or trans-vaginal techniques. The morbidity is lower than the trans-abdominal route. Comments, TEMS is a useful technique for the repair of benign recto-vaginal fistula and has distinct advantages over conventional techniques. [source] | ||||||||||