Developing case‐finding algorithms for second events of oropharyngeal cancer using administrative data: A population‐based validation study

Abstract

Background

Second event (recurrence or second primary cancer)‐free survival is an important indicator for assessing treatment efficacy. However, second events are not explicitly documented in administrative data such as cancer registries. Thus, validated algorithms using administrative data are needed to identify second events of oropharyngeal cancers.

Methods

The algorithms were developed using classification and regression tree models. Data from chart review served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results

The high‐sensitivity algorithm achieved 87.9% (95% confidence interval: 82.2%‐93.6%) sensitivity, 84.5% (81.1%‐87.8%) specificity, 61.2% (54.1%‐68.4%) PPV, 96.2% (94.2%‐98.1%) NPV, and 85.2% (82.3%‐88.1%) accuracy. The high‐PPV algorithm obtained 52.4% (43.6%‐61.2%) sensitivity, 99.1% (98.2%‐100.0%) specificity, 94.2% (88.7%‐99.7%) PPV, 88.2% (85.3%‐91.0%) NPV, and 88.9% (86.3%‐91.5%) accuracy.

Conclusion

The validity of the algorithms for identifying second events following primary treatment of oropharyngeal cancers was acceptable.

http://bit.ly/2t1TuOo

Ten‐year outcome of curative “exclusive” chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx with complete clinical response

Abstract

Background

The aim of our study was to document 10‐year outcome after curative "exclusive" chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx.

Methods

Retrospective nonrandomized analysis of an inception cohort of 191 patients. Platinum salt and 5‐fluorouracil were used in all patients.

Results

The 3‐, 5‐, 10‐year overall actuarial survival and local control estimates were 83.3%, 74.4%, and 55.4% and 62.1%, 62.1%, and 55.3%, respectively. Main causes of death were metachronous second primary cancer (n = 39) and intercurrent disease (n = 28). No clinical variables were associated with increased risk of local recurrence. Salvage treatment resulted in 94.7% ultimate local control and 88.4% organ preservation. "Exclusive" chemotherapy was considered "beneficial" in 62.3% and "detrimental" in 7.8% of cases.

Conclusion

The high rate of local recurrence may be thought not to justify this treatment. Nevertheless, many patients avoided surgery and remained free of disease. Therefore, this approach deserves further study in the era of immune checkpoints inhibitors.

http://bit.ly/2HKEXkk

Marked responses to pemetrexed chemotherapy for metastatic adenocarcinoma of the parotid gland: Case series

Abstract

Background

There are no proven systemic therapies for metastatic adenocarcinoma of the salivary glands. Pemetrexed use in adenocarcinoma of the salivary glands has not been previously described.

Methods

Retrospective case reports and literature review.

Results

Two patients with metastatic salivary gland adenocarcinoma were treated with single‐agent pemetrexed with marked response and clinical benefit. Case 1 describes a sustained clinical response for 8 months after failing several lines of chemotherapy. Case 2 describes a marked interval response of diffuse metastatic disease at 2 months with resolution of bone pain and sustained response at 8 months.

Conclusion

To our knowledge, this is the first report of efficacy of single‐agent pemetrexed for metastatic salivary gland adenocarcinoma. Given the significant and sustained responses in heavily pretreated patients, further investigation of pemetrexed for salivary cancer may be warranted.

http://bit.ly/2sZf7P8

Sellar and Parasellar Pain Syndromes

Abstract

Purpose of Review

Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically.

Recent Findings

In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment.

Summary

Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.

http://bit.ly/2HJdFdN

Exploring The Role Of FGFR2c Misregulation In Syndromic Craniosynostosis

Lee, King Lam; (2018) Exploring The Role Of FGFR2c Misregulation In Syndromic Craniosynostosis. Doctoral thesis (Ph.D), UCL (University College London). Green open access

http://bit.ly/2sYS0nT

Primary Prevention of Food Allergy

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy.

Recent Findings

Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation.

Summary

The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

http://bit.ly/2Ts4Jv0

Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach

Abstract

Purpose of Review

The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored.

Recent Findings

This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile.

Summary

This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.

http://bit.ly/2BipHFx