Adenoid cystic carcinoma has a long natural history but frequently proves fatal. The present study describes 108 patients with an adenoid cystic carcinoma of the head and neck seen over a 30-year period. Analysis of the data utilized both univariate and multivariate methods. Forty per cent of patients had tumours arising from the oral cavity and half of these were in the hard palate; 29% occurred in the major salivary glands; 41% of tumours were locally advanced at presentation and 11% had lymph node metastases at this time. The histological pattern was solid in 25%, cribriform in 40% and tubular in 20%. In addition, 15% of patients had a polymorphous low-grade adenocarcinoma and these were analysed separately. Primary site recurrence was more common in the presence of locally advanced tumours at presentation (T3-4) (P = 0.0093). Only six patients had surgery with adjuvant radiotherapy. Six patients had no curative treatment, 21 had primary radiotherapy, 39 had local excision and 42 radical excision. The actuarial primary site recurrence rate was 100% at 30 years. The neck node recurrence rate was 23% at 15 years. Tumour specific survival was 40% at 20 years. Solid histology had a worse prognosis than other histological types (P = 0.0429) but those patients with polymorphous low-grade adenocarcinomas fared very well. Patients with tumours of the hard palate fared better than those patients with tumours at other sites (P = 0.0301). Early disease at the primary site (T1-2) was a good prognostic sign (P = 0.0013). Patients with neck node metastases at presentation tended to do badly (P = 0.009).
The RFCstandard model performance is modest-to-good, but should be improved, and requires external validation. Reducing the volumes of oral cavity receiving intermediate and high doses may reduce mucositis incidence.
Severe acute dysphagia commonly results from head and neck radiotherapy (RT). A model enabling prediction of severity of acute dysphagia for individual patients could guide clinical decision-making. Statistical associations between RT dose distributions and dysphagia could inform RT planning protocols aiming to reduce the incidence of severe dysphagia. We aimed to establish such a model and associations incorporating spatial dose metrics. Models of severe acute dysphagia were developed using pharyngeal mucosa (PM) RT dose (dose-volume and spatial dose metrics) and clinical data. Penalized logistic regression (PLR), support vector classification and random forest classification (RFC) models were generated and internally (173 patients) and externally (90 patients) validated. These were compared using area under the receiver operating characteristic curve (AUC) to assess performance. Associations between treatment features and dysphagia were explored using RFC models. The PLR model using dose-volume metrics (PLRstandard) performed as well as the more complex models and had very good discrimination (AUC = 0.82) on external validation. The features with the highest RFC importance values were the volume, length and circumference of PM receiving 1 Gy/fraction and higher. The volumes of PM receiving 1 Gy/fraction or higher should be minimized to reduce the incidence of severe acute dysphagia.
Purpose Current normal tissue complication probability modeling using logistic regression suffers from bias and high uncertainty in the presence of highly correlated radiation therapy (RT) dose data. This hinders robust estimates of dose-response associations and, hence, optimal normal tissue—sparing strategies from being elucidated. Using functional data analysis (FDA) to reduce the dimensionality of the dose data could overcome this limitation. Methods and Materials FDA was applied to modeling of severe acute mucositis and dysphagia resulting from head and neck RT. Functional partial least squares regression (FPLS) and functional principal component analysis were used for dimensionality reduction of the dose-volume histogram data. The reduced dose data were input into functional logistic regression models (functional partial least squares—logistic regression [FPLS-LR] and functional principal component—logistic regression [FPC-LR]) along with clinical data. This approach was compared with penalized logistic regression (PLR) in terms of predictive performance and the significance of treatment covariate—response associations, assessed using bootstrapping. Results The area under the receiver operating characteristic curve for the PLR, FPC-LR, and FPLS-LR models was 0.65, 0.69, and 0.67, respectively, for mucositis (internal validation) and 0.81, 0.83, and 0.83, respectively, for dysphagia (external validation). The calibration slopes/intercepts for the PLR, FPC-LR, and FPLS-LR models were 1.6/−0.67, 0.45/0.47, and 0.40/0.49, respectively, for mucositis (internal validation) and 2.5/−0.96, 0.79/−0.04, and 0.79/0.00, respectively, for dysphagia (external validation). The bootstrapped odds ratios indicated significant associations between RT dose and severe toxicity in the mucositis and dysphagia FDA models. Cisplatin was significantly associated with severe dysphagia in the FDA models. None of the covariates was significantly associated with severe toxicity in the PLR models. Dose levels greater than approximately 1.0 Gy/fraction were most strongly associated with severe acute mucositis and dysphagia in the FDA models. Conclusions FPLS and functional principal component analysis marginally improved predictive performance compared with PLR and provided robust dose-response associations. FDA is recommended for use in normal tissue complication probability modeling.
Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early access failure (EAF) as well as ischemic heart disease (IHD) (Am J Kidney Dis. 2003; 41: 422-428). Objective: This study was designed to determine the impact of IHD on the EAF in nondiabetic HD patients. Methods: This study enrolled 125 nondiabetic HD patients who received radiocephalic arteriovenous fistula operation for the first time. We evaluated IHD before the operation through clinical symptoms and electrocardiography and then investigated EAF within 1 year after the operation. We analyzed the access patency rates between the patients with and without IHD, using Kaplan-Meier method and log-rank test. Multiple regression analysis was performed to identify independent risk factors of the EAF. Results: The mean age of the patients was 48 AE 14 years, and the number of females was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the operation. The EAF developed in 23 patients (18.4%) within 1 years after the operation. The access patency rate in the patients with IHD was lower than that in the patients without IHD (39.7 vs. 88.3%, p < 0.001). IHD and old age were independent risk factors of the EAF in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the EAF. Conclusion: This study suggests that IHD is closely associated with EAF in nondiabetic HD patients. Dialysis Staff Time and SupplyCost for the LifeSite System vs. Hemodialysis Catheters D. Shore, S. Vega. West Palm Dialysis --Preferred Medical Group, West Palm Beach, FL, U.S.A.The LifeSite System is a new subcutaneous vascular access option for hemodialysis patients. As the procedure for accessing the Life-Site differs from hemodialysis catheters, we prospectively studied the differences in time required to initiate and discontinue treatments for LifeSite patients compared to patients with hemodialysis catheters. We also collected data on the cost of supplies and the number of alarms during dialysis for both groups. 5 LifeSite and 5 catheter patients were chosen at random for participation in the study. The time required for the ON and OFF procedures was recorded for 3 consecutive dialysis sessions for each patient for a total of 15 observations/group. The average staff time required per session for supply preparation, ON/OFF procedure, dressing changes, and responding to alarms was 15.9 min for the LifeSite and 16.9 min for catheters. Catheter patients experienced 4.5Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to
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