PurposeTo evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with 90Y-loaded glass microspheres (TheraSphere®).MethodsTheraSphere® was administered to 71 patients with inoperable HCC. MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), healthy injected liver dose (HILD), and total injected liver dose. Response was evaluated at 3 months using EASL criteria. Time to progression (TTP) and overall survival (OS) were evaluated using the Kaplan-Meier method. Factors potentially associated with liver toxicity were combined to construct a liver toxicity score (LTS).ResultsThe response rate was 78.8 %. Median TD were 342 Gy for responding lesions and 191 Gy for nonresponding lesions (p < 0.001). With a threshold TD of 205 Gy, MAA SPECT/CT predicted response with a sensitivity of 100 % and overall accuracy of 90 %. Based on TD and HILD, 17 patients underwent treatment intensification resulting in a good response rate (76.4 %), without increased grade III liver toxicity. The median TTP and OS were 5.5 months (2–9.5 months) and 11.5 months (2–31 months), respectively, in patients with TD <205 Gy and 13 months (10–16 months) and 23.2 months (17.5–28.5 months), respectively, in those with TD >205 Gy (p = 0.0015 and not significant). Among patients with portal vein thrombosis (PVT) (n = 33), the median TTP and OS were 4.5 months (2–7 months) and 5 months (2–8 months), respectively, in patients with TD <205 Gy and 10 months (6–15.2 months) and 21.5 months (12–28.5 months), respectively, in those with TD >205 Gy (p = 0.039 and 0.005). The median OS was 24.5 months (18–28.5 months) in PVT patients with TD >205 Gy and good PVT targeting on MAA SPECT/CT. The LTS was able to detect severe liver toxicity (n = 6) with a sensitivity of 83 % and overall accuracy of 97 %.ConclusionDosimetry based on MAA SPECT/CT was able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved.

SUMMARY A simple alternative to the proportional hazards model is considered, whereby the regression coefficients can vary with time. It leads to a statistic which can be used for checking the assumption of proportional hazards. In the two‐sample problem, this statistic is the same as Schoenfeld's (1980); a conservative version, computationally simple, is proposed in this case.

Objective. To develop a reliable and valid measure of patient opinions on quality of hospital care.Design. Issues of importance to patients and possible scale items were generated by literature review and non-structured interviews of patients, former patients, health care providers and researchers. Semi-structured interviews with inpatients and pilot studies were conducted to modify or remove ambiguous questions and reduce skewed responses. A study was then made to select from these questions relevant items and variables correlated to patient evaluation of quality of care. A principal-components analysis was performed to select items and assess construct validity. Cronbach's coefficients were calculated to estimate the reliability of the scale. Time reliability and concurrent validity were also considered.Setting. An 800-bed French short-stay teaching hospital in Paris.Study participants. Five-hundred and thirty-four consecutive patients hospitalized in eight medical and surgical wards.Results. A 26-item scale was developed. Component analysis indicated two subscales: 'medical information' and 'relationship with staff and daily routine'. Levels of reliability were satisfactory: Cronbach's coefficient exceeded 0.87 for overall scale and subscales. Concurrent validity and time reliability were also satisfactory. Multivariate analysis showed that, taking into account patients and hospitalization characteristics linked to scores (age, health status, number of hospitalizations, comorbidity, time since diagnosis, admission pattern, private patient and difficulties reported by staff ), these scores differed among departments. Conclusion.A reliable, valid measure of inpatients' opinions on quality of care has been developed in a French hospital and variables that have to be taken into account to compare hospital departments have been selected. Items selected in the scale emphasized the importance that patients give to receiving medical information. Keywords: hospitalization, inpatient, patient satisfaction, psychometric testingPatient satisfaction is increasingly recognized as an important health care providers and regulators to locate and solve problems that can improve the quality of care [11,12]. This dimension of quality of care [1][2][3]. From the hospital's perspective, the patient's view of care is important to both increased importance of measuring patient satisfaction raises critical questions about the quality and validity of a patient clinical and management staff and patient satisfaction is predictive of future behaviour such as compliance with satisfaction measurement system. In addition, patient expectations and priorities vary among countries and are highly treatment and intent to return for care [4][5][6][7][8].During the last decade, a number of measures of perceived related to cultural background and to the health care system [10][11][12][13][14][15]. The French health care system clearly differs from quality of care and patient satisfaction have been developed with varying evidence of validity...

No abstract

No abstract