We compared concurrent combination chemotherapy and radiotherapy with surgery and adjuvant radiotherapy in patients with stage III/IV nonmetastatic squamous cell head and neck cancer. Patients with non-nasopharyngeal and nonsalivary resectable squamous cell head and neck cancer were randomised to receive either surgery followed by adjuvant radiotherapy (60 Gy over 30 fractions) or concurrent combination chemotherapy and radiotherapy (66 Gy in 33 fractions). Combination chemotherapy comprised two cycles of i.v. cisplatin 20 mg m À2 day À1 and i.v. 5-fluorouracil 1000 mg m À2 day À1 , both to run over 96 h given on days 1 and 28 of the radiotherapy. A total of 119 patients were randomised. At a median follow-up of 6 years, there was no significant difference in the 3-year disease-free survival rate between the surgery and concurrent chemoradiotherapy (50 vs 40% respectively). The overall organ preservation rate or avoidance of surgery to primary site was 45%. Those with laryngeal/hypopharyngeal disease subsite had a higher organ-preservation rate than the rest (68 vs 30%). Combination chemotherapy and concurrent irradiation with salvage surgery was not superior to conventional surgery and postoperative radiotherapy for resectable advanced squamous cell head and neck cancer. However, this form of treatment schedule with a view to organ-preservation can be attempted especially for those with laryngeal/hypopharyngeal and possibly oropharyngeal disease subsites. The majority of the patients with squamous cell head and neck cancer (SCHNC) present with locally and/or regionally advanced disease and the use of radical surgery and/or radiotherapy in this setting yield low locoregional control rates and 5-year survival rates not exceeding 40%.The administration of chemotherapy and radiotherapy concurrently makes use of the resultant synergistic activity to improve tumour cell kill. This strategy has found success in anal canal carcinoma, allowing high cure rates while obviating the need for radical surgery. Studies carried out in the 1990s using combination chemotherapy with concurrent radiation in SCHNC have shown this treatment approach to be feasible despite the significantly higher toxicity and have produced encouraging results. Adelstein et al in a phase II trial using cisplatin (CDDP) and 5-fluorouracil (5FU) combination with concurrent split-course radiotherapy have reported a 4-year relapse-free survival of 45% and an overall survival of 49% (Adelstein et al, 1993). This when compared retrospectively with a similar patient population treated with radiation alone was shown to be improved. Adelstein next investigated the use of the same combination regimen concurrently with a continuous course of radiotherapy (Adelstein et al, 1994). In 19 patients treated in this fashion, despite significant toxicity, there were no treatment-related deaths. At a median follow-up of 20 months, the projected Kaplan -Meier estimate of locoregional disease control was 92%, with the projected relapse-free survival of 86%. Of significance...
A practically useful measure of quality of life should be simple and quick to complete. A shortened Chinese version of the Functional Living Index -Cancer (FLIC) was recently proposed and was called Quick-FLIC. This study aims to assess the measurement properties of the Quick-FLIC. A total of 190 patients who received care from the National Cancer Centre of Singapore completed a questionnaire package at baseline. Patients filled in a retest questionnaire on average 2 weeks after baseline to assess test -retest reliability and responsiveness to change. The Quick-FLIC scores correlated well with the Functional Assessment of Chronic TherapyGeneral scores (r ¼ 0.78). Patients with different treatment status, performance status and self-rated health had significantly different Quick-FLIC scores in the expected directions (ANOVA; each Po0.001). Internal consistency (Cronbach's alpha ¼ 0.87) and 2-week test -retest reliability (intraclass correlation ¼ 0.81) were also satisfactory. The measure was responsive to changes in health status (Po0.001). The Quick-FLIC is a valid and reliable measure of health-related quality of life of cancer patients. The shortening of established health-related quality of life instruments should be considered in order to reduce the burden of having patients to answer lengthy questionnaires.
300 words) 50 51 StW 573, from Sterkfontein Member 2, dated ca 3.67 Ma, is by far the most complete 52 skeleton of an australopith to date. Joint morphology is in many cases closely matched in 53 available elements of Australopithecus anamensis (eg. proximal and distal tibial and humeral 54 joint-surfaces) and there are also close similarities to features of the scapula, in particular , of 55 KSD-VP-1/1 A. afarensis from Woranso-Mille. The closest similarities are, however, to the 56 partial skeleton of StW 431 from Sterkfontein Member 4. When considered together, both 57 StW 573 and StW 431 express an hip joint morphology quite distinct from that of A. 58 africanus Sts14, and a proximal femur of a presumed A. africanus from Jacovec Cavern at 59 Sterkfontein, StW 598. This, and other evidence presented herein, suggests there are two 60 pelvic girdle morphs at Sterkfontein, supporting Clarke (2013) in his recognition of a second 61 3 species, A. prometheus, containing StW 573 and StW 431. StW 573 is the first hominid 62 skeleton where limb proportions are known unequivocally. It demonstrates that some early 63 hominins, at the time of formation of the Laetoli footprints (3.6 Ma), were large-bodied. with 64 hindlimbs longer than forelimbs. Modelling studies on extant primates indicate that the 65 intermembral index (IMI) of StW 573, low for a non-human great ape, would have 66 substantially enhanced economy of bipedal walking over medium-to-long distances, but that 67 it was still too high for effective walking while load-carrying. It would, however, have 68 somewhat reduced the economy of horizontal climbing, but made Gorilla-like embracing of 69 large tree-trunks less possible. Consideration of both ethnographic evidence from modern 70 indigenous arboreal foragers and modern degeneracy theory cautions against prescriptive 71 interpretations of hand-and foot-function, by confirming that both human-like upright 72 bipedalism and functional capabilities of the hand and foot can be effective in short-distance 73 arboreal locomotion. 74 75 1. Introduction 76 77While it is now largely accepted that there was no phase of terrestrial knucklewalking in 78 hominin evolution (see eg., Dainton and Macho, 1999; Dainton, 2001; Clarke, 2002; Kivell 79 and Schmitt, 2009), and that australopiths show adaptations to both terrestrial bipedalism and 80 arboreal locomotion, there is still no firm consensus on whether the 'arboreal' features of 81 australopith postcrania would have been the subject of positive selection or were selectively 82 neutral anachronisms (Ward 2002(Ward , 2013. The view that the two activities must be 83 substantially mechanically incompatible is still current (see eg., Kappelman et al., 2016). The 84 two alternative paradigms date from extended debates (see eg., Latimer, 1991 versus Stern 85 and Susman, 1991) concerning the significance of the AL-288-1 'Lucy' skeleton of 86 Australopithecus afarensis in 1974. Although some one-third complete, this partial skeleton, 87 and other more recently discovered...
A useful measure of quality of life should be easy and quick to complete. Recently, we reported the development and validation of a shortened Chinese version of the Functional Living Index -Cancer (FLIC), which we called the Quick-FLIC. In the present study of 327 English-speaking and 221 Chinese-speaking cancer patients, we validated the English version of the Quick-FLIC and further assessed the Chinese version. The 11 Quick-FLIC items were administered alongside the 11 remaining items of the full FLIC, but there appeared to be little context effect. Validity of the English version of the Quick-FLIC was attested by its strong correlation with two other measures of quality of life, and its ability to detect differences between patients with different performance status and treatment status (each Po0.001). Its internal consistency (alpha ¼ 0.86) and test -retest reliability (intraclass correlation ¼ 0.76) were also satisfactory. The measure was responsive to changes in performance status (Po0.001). The Chinese version showed similar characteristics. The Quick-FLIC behaved in ways that are highly comparable with the FLIC, even though the Quick-FLIC comprised only 11 items whereas the FLIC comprised 22. Further research is required to see whether the use of shorter instruments can improve data quality and response rates, but the fact that shorter instruments place less burden on the patients is itself inherently important.
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