Background: The effect of brain surgery on the clinical outcome of patients with nonsmall-cell lung cancer (NSCLC) and brain metastases (BM), particularly those with epidermal growth factor receptor (EGFR) mutations, has not been studied yet. We aimed to investigate whether brain surgery can improve the survival of patients with stage IV EGFR-mutant NSCLC who were treated with both first-line tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy (WBRT). Methods: We searched the database for lung cancer patients diagnosed from 2011 to 2016 in one Asian university hospital. NSCLC patients who also had brain metastases diagnosed by either cytology or brain neuroimaging studies were identified. The treatments and clinical outcomes were reviewed. Overall survivals (OS) were estimated by Kaplan-Meier curves. Cox regression was performed. Results: Of 1394 NSCLC patients, we identified 100 patients with lung adenocarcinoma who had received both WBRT and TKIs. Most patients (60%) had been treated with brain surgery (BS þ RT group). All patients had TKIs. The median duration of TKIs use was 14.4 months (95% confidence interval (CI), 10.7-17.9). All patients had WBRT with a mean radiation dose of 37796748 cGy to their brain metastases. With a median follow-up of 25.6 months (95% CI, 18.6-35.7), the median survival after BM was 18.2 months (95% CI, 10.8-27.4) for patients who underwent brain surgery (TKI þ BS þ RT group) and 11.8 months (95% CI, 5.2-18) for patients who did not accept brain surgery (TKI þ RT group). The mean survival after BM were 21.9614.8 months and 15.6614.5 months for patients with and without brain surgery, respectively (P ¼ 0.026). Univariate analysis suggested that female gender, exon 19 mutation, brain surgery and solitary brain metastasis were favorable prognostic factors for longer survival. However, brain surgery failed to demonstrate its efficacy in multivariate analysis (P ¼ 0.134, hazard ratio ¼ 0.69).
Background
Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings can be generalized to Asian patients, or that similar LDL‐C targets should be adopted in patients with stroke without significant atherosclerosis.
Methods and Results
We performed a prospective cohort study and recruited consecutive Chinese patients with ischemic stroke with magnetic resonance angiography of the intra‐ and cervicocranial arteries performed at the University of Hong Kong between 2008 and 2014. Serial postevent LDL‐C measurements were obtained. Risk of major adverse cardiovascular events in patients with mean postevent LDL‐C <1.80 versus ≥1.80 mmol/L, stratified by presence or absence of significant (≥50%) large‐artery disease (LAD) and by ischemic stroke subtypes, were compared. Nine hundred four patients (mean age, 69±12 years; 60% men) were followed up for a mean 6.5±2.4 years (mean, 9±5 LDL‐C readings per patient). Regardless of LAD status, patients with a mean postevent LDL‐C <1.80 mmol/L were associated with a lower risk of major adverse cardiovascular events (with significant LAD: multivariable‐adjusted subdistribution hazard ratio, 0.65; 95% CI, 0.42–0.99; without significant LAD: subdistribution hazard ratio, 0.53; 95% CI, 0.32–0.88) (both
P
<0.05). Similar findings were noted in patients with ischemic stroke attributable to large‐artery atherosclerosis (subdistribution hazard ratio, 0.48; 95% CI, 0.28–0.84) and in patients with other ischemic stroke subtypes (subdistribution hazard ratio, 0.64; 95% CI, 0.43–0.95) (both
P
<0.05).
Conclusions
A mean LDL‐C <1.80 mmol/L was associated with a lower risk of major adverse cardiovascular events in Chinese patients with ischemic stroke with and without significant LAD. Further randomized trials to determine the optimal LDL‐C cutoff in stroke patients without significant atherosclerosis are warranted.
Introduction: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radiotherapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis.Methods: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates.Results: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States.Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or infiltrates were observed in eight patients.Conclusions: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing
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