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Background-Although some patients with adult congenital heart disease (ACHD) report limitations in exercise capacity, we hypothesized that depressed exercise capacity may be more widespread than superficially evident during clinical consultation and could be a means of assessing risk. Methods and Results-Cardiopulmonary exercise testing was performed in 335 consecutive ACHD patients (age, 33Ϯ13 years), 40 non-congenital heart failure patients (age, 58Ϯ15 years), and 11 young (age, 29Ϯ5 years) and 12 older (age, 59Ϯ9 years) healthy subjects. Peak oxygen consumption (peak V O 2 ) was reduced in ACHD patients compared with healthy subjects of similar age (21.7Ϯ8.5 versus 45.1Ϯ8.6; PϽ0.001). No significant difference in peak V O 2 was found between ACHD and heart failure patients of corresponding NYHA class (PϭNS for each NYHA class). Within ACHD subgroups, peak V O 2 gradually declined from aortic coarctation (28.7Ϯ10.4) to Eisenmenger (11.5Ϯ3.6) patients (PϽ0.001). Multivariable correlates of peak V O 2 were peak heart rate (rϭ0.33), forced expiratory volume (rϭ0.33), pulmonary hypertension (rϭϪ0.26), gender (rϭϪ0.23), and body mass index (rϭϪ0.19). After a median follow-up of 10 months, 62 patients (18.5%) were hospitalized or had died. On multivariable Cox analysis, peak V O 2 predicted hospitalization or death (hazard ratio, 0.937; Pϭ0.01) and was related to the frequency and duration of hospitalization (Pϭ0.01 for each). Conclusions-Exercise capacity is depressed in ACHD patients (even in allegedly asymptomatic patients) on a par with chronic heart failure subjects. Lack of heart rate response to exercise, pulmonary arterial hypertension, and impaired pulmonary function are important correlates of exercise capacity, as is underlying cardiac anatomy. Poor exercise capacity identifies ACHD patients at risk for hospitalization or death. (Circulation. 2005;112:828-835.)

ClinicalTrials.gov: NCT02150603.

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The Head and Neck Working Group of the GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Therapeutic Radiology and Oncology) published in 2009 the consensus recommendations for low-dose rate, pulsed-dose rate and high-dose rate brachytherapy in head & neck cancers. The use of brachytherapy in combination with external beam radiotherapy and/or surgery was also covered as well as the use of brachytherapy in previously irradiated patients. Given the developments in the field, these recommendations needed to be updated to reflect up-to-date knowledge. The present update does not repeat basic knowledge which was published in the first recommendation but covers in a general part developments in (1) dose and fractionation, (2) aspects of treatment selection for brachytherapy alone versus combined BT+EBRT and (3) quality assurance issues. Detailed expert committee opinion intends to help the clinical practice in lip-, oral cavity-, oropharynx-, nasopharynx-, and superficial cancers. Different aspects of adjuvant treatment techniques and their results are discussed, as well the possibilities of salvage brachytherapy applications.

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