The development of patient information leaflets. Care of the mouth after radiotherapy

Objectives: Describe the methodology used to produce a patient leaflet on care of the mouth after radiotherapy. Design: Prospective study to design a patient information leaflet. Setting and Subjects : Patients undergoing radiotherapy for oral cancer. Intervention: After a review of the relevant literature, a patient questionnaire was produced. This was then completed by patients undergoing radiotherapy treatment and gave an indication of the problems being encountered. Healthcare professionals were surveyed for their views. A leaflet was then produced according to published guidelines. It was taken back to another group of patients and a further version produced after input from a health promotion group. Results: A leaflet was produced after wide consultation and survey. Conclusion: Considerable effort must to be put into the production of patient information leaflet. It must be discussed with patients in the target group if it is to be sensitive, understood and find acceptance among its users     

Running economy deteriorates following 60?min of exercise at 80% V˙O2max

Fifteen young adult Singaporean male physical education students maximum oxygen consumption [(V˙O_2max) = 56 (4.7) ml · kg⁻¹ · min⁻¹] performed three prolonged runs in a counterbalanced design. The running bouts varied in time (40 vs 60 min) and intensity (70% vs 80% V˙O_{2 max} ). Each prolonged run was separated by 7 days. The running economy (RE) at 10.8 km · h⁻¹ during 10-min running bouts was measured before (RE1) and after (RE2) each prolonged run. A control study involved monitoring RE at 10.8 km · h⁻¹ before and after 60 min rest. There were no differences between RE1 and RE2 values during the control run. However, there were differences between RE1 and RE2 values when separated by a prolonged run. For example, the mean (SD) changes in oxygen consumption (ml · kg⁻¹ · min⁻¹) values were 38.2 (2.5) versus 40.1 (2.6) (40 min at 80% V˙O_{2 max} ), 38.9 (2.8) versus 41.5 (2.6) (60 min at 70% V˙O_{2 max} ), and 39.0 (3.1) versus 42.7 (2.9) (60 min at 80% V˙O_{2 max} ; P < 0.01). The results of this investigation support the hypothesis that RE deteriorates during prolonged running, and that the magnitude of the deterioration in RE increases with both increasing exercise intensity and duration. Accepted: 14 July 1997     

Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy

Background and purposeBreast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material.Materials and methodsRetrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications.Results251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23–9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60–4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97–11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048–0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26–9.99, p = 0.016) were related to late complications.ConclusionsThe overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.     

Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies — a prospective observational study

BackgroundIntensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies. The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied.Materials and methods40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m².ResultsProportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = −0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5–41 Hz) with significant increase in roughness of voice post treatment (p = 0.01).ConclusionThere was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.     

Should the management of radiation therapy for breast cancer be standardized? Results of a survey on current French practices in breast radiotherapy

BackgroundBreast cancer is the most frequent cancer in women in France. Its management has evolved considerably in recent years with a focus on reducing iatrogenic toxicity. The radiotherapy indications are validated in multidisciplinary consultation meetings; however, questions remain outstanding, particularly regarding hypofractionated radiotherapy, partial breast irradiation, and irradiation of the internal mammary chain and axillary lymph node area.Materials and methodsAn online survey was sent to 47 heads of radiotherapy departments in France. The survey consisted of 22 questions concerning indications for irradiation of the supraclavicular, internal mammary and axillary lymph node areas; irradiation techniques and modalities; prescribed doses; and fractionation.ResultsTwenty-four out of 47 centers responded (response rate of 51%). This survey demonstrated a wide variation in the prescribed dose regimen, monoisocentric radiotherapy, and indications of irradiation of the lymph node areas.ConclusionThis survey provides insight into the current radiotherapy practice for breast cancer in France. It shows the need to standardize practices.     

Non-Homogeneous Gibbs Process Models for Forestry — A Case Study

Forestry statistics needs realistic models for non-homogeneously distributed trees in forests. For elder trees, non-homogeneous Poisson or Cox processes are not realistic models. Instead, non-homogeneous Gibbs processes are suggested, which are described by a fixed pair potential describing the short-range interaction of trees and a location dependent intensity function describing long-range variation of tree density. The application of this model is demonstrated for a hickory forest in North Carolina and an artificial forest stand.     

Impact of rotational errors of whole pelvis on the dose of prostate-based image-guided radiotherapy to pelvic lymph nodes and small bowel in high-risk prostate cancer

BackgroundThe target volume increases when the prostate and pelvic lymph nodes (PLNs) are combined, and the fiducial markers (FMs) are placed at the edge of the irradiation field. Thus, the position of FMs may be changed by the rotational errors (REs) of “whole pelvis”. The aim of this study was to examine the impact of REs of “whole pelvis” on the dose of FMs-based image-guided radiotherapy to the PLNs and the small bowel in prostate cancer including the PLNs.Materials and methodsWe retrospectively evaluated 10 patients who underwent prostate cancer radiotherapy involving the PLNs. The position of FMs was calculated from the radiographs obtained before and after the 6D correction of pelvic REs. We simulated the delivery dose considering the daily pelvic REs and calculated the difference from the planned dose in the D_98% of the PLN clinical target volume and the D_2cc, and V_45Gy of the small bowel.ResultThe position of FMs strongly correlated with the pelvic REs in the pitch direction (r = 0.7788). However, the mean delivered doses to PLNs for 10 patients were not significantly different from the planned doses (p = 0.625). Although the D_2cc and V_45Gy of the small bowel strongly correlated with the pitch rotation of the pelvis, there was no significant difference between the delivered and planned doses (p = 0.922 and p = 0.232, respectively).ConclusionThe dosimetric effect of pelvic REs on the dose to PLNs and the small bowel was negligible during the treatment course.     

多野照射、三维适形放疗与调强放疗对胃癌根治术患者癌周围组织的影响

目的:探讨多野照射、三维适形放疗与调强放疗对胃癌根治术患者癌周围组织的影响。方法:选取收治的103例行胃癌根治术的患者,将所有患者随机分为甲乙丙三组,其中甲组患者34例,均采用多野照射治疗;而乙组患者也是34例,均使用三维适形放疗;丙组患者则有35例,均使用调强放疗。观察比较各组患者放疗后的上腹部症状改善情况,并且检测各组患者的肝功能和血常规以及胰淀粉酶等临床指标,比较各组患者经治疗后的复发率以及生存率。结果:甲组患者的近期疗效显著低于乙组患者(P0.05),而乙组患者的近期疗效则明显低于丙组患者(P0.05);三组患者的钡餐造影均有所改善,但是其组间比较差异不具有统计学意义(÷2=9.012,P0.05)。甲组的不良反应率显著高于乙组和丙组(均P0.05),并且各组患者的不良反应中血常规异常的发生率显著高于肝功能和胰脏功能的异常(均P0.05),同时甲组患者出现放射性脊髓病的患者明显多于乙组(P0.05),仅丙组患者未见放射性脊髓病。随访三年间三组患者第一年随访生存率无明显差异(P0.05),而在第2年至第3年则三组患者的随访生存率有明显差异(均P0.05),其中随访生存率以丙组患者最高,其次为乙组患者;另外随访三年间甲组患者的随访复发率显著高于乙组和丙组患者(均P0.05),其复发率由低至高依次为丙组乙组甲组。结论:与多野照射治疗相比,三维适形放疗和调强放疗均能够更好地降低对胃癌周围组织的损伤和改善患者的临床症状,并且不良反应发生率低,对于降低复发率和提高生存率方面亦有不错的效果。     

Dream Intensity Inventory and Chinese people's dream experience frequencies.

The present study aimed to devise a parsimonious instrument for evaluating both the quantitative and qualitative aspects of dream experiences and to quantify Chinese people's dream experiences in ways that facilitated cross-cultural comparisons. The Dream Intensity Inventory was developed and administered to 348 Chinese university students. Individual differences in dream recall frequency were observed, with some participants recalling dreams almost every morning whereas others recalled dreams less than once a month. By contrast, the Chinese participants exhibited less diverse dream awareness frequencies. Multiple dreams in a single night and nightmares were found to be prevalent among the Chinese participants. On the other hand, fewer than half of the participants experienced regularly voluntary control over dream activities and consciousness. The factor analyses of the items in the Dream Intensity Inventory resulted in three readily interpreted factors, which were labeled as the "dream quantity," "altered dream episodes," and "dream vividness" subscales, respectively. When compared with men, women participants had higher frequencies of regular dream experiences including dream awareness, nightmares, and multiple dreams, as measured by the dream quantity subscale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radionuclide carriers for targeting of cancer

This review describes strategies for the delivery of therapeutic radionuclides to tumor sites. Therapeutic approaches are summarized in terms of tumor location in the body, and tumor morphology. These determine the radionuclides of choice for suggested targeting ligands, and the type of delivery carriers. This review is not exhaustive in examples of radionuclide carriers for targeted cancer therapy. Our purpose is two-fold: to give an integrated picture of the general strategies and molecular constructs currently explored for the delivery of therapeutic radionuclides, and to identify challenges that need to be addressed. Internal radiotherapies for targeting of cancer are at a very exciting and creative stage. It is expected that the current emphasis on multidisciplinary approaches for exploring such therapeutic directions should enable internal radiotherapy to reach its full potential.