Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery) hyperintensity of the mesial temporal lobes, and there were anti-Ma2 antibodies in both serum and cerebrospinal fluid. She was treated with corticosteroids but developed further clinical relapses requiring immunoglobulin and rituximab. The immune-related adverse events relating to immune checkpoint inhibitors are an emerging challenge for the neurologist. Some cases are refractory and require serial immunosuppression.
The paper deals with the evaluation of the performance of an existing and previously validated CT based radiomic signature, developed in oropharyngeal cancer to predict human papillomavirus (HPV) status, in the context of anal cancer. For the validation in anal cancer, a dataset of 59 patients coming from two different centers was collected. The primary endpoint was HPV status according to p16 immunohistochemistry. Predefined statistical tests were performed to evaluate the performance of the model. The AUC obtained here in anal cancer is 0.68 [95% CI (0.32–1.00)] with F1 score of 0.78. This signature is TRIPOD level 4 (57%) with an RQS of 61%. This study provides proof of concept that this radiomic signature has the potential to identify a clinically relevant molecular phenotype (i.e., the HPV-ness) across multiple cancers and demonstrates potential for this radiomic signature as a CT imaging biomarker of p16 status.
BackgroundIt has been shown that patients with a greater tumour volume have poorer outcomes following definitive radiotherapy but its exact role remains unclear. The purpose of this study is to investigate the role of tumour volume as a prognostic indicator in non-small cell lung cancer (NSCLC) patients treated with definitive radiotherapy in a single institution over 10 years.MethodsIn total, 167 patients with NSCLC treated by definitive (chemo)radiotherapy were retrospectively reviewed between 2006 and 2015. Patient demographics, disease characteristics and tumour volume parameters were collected. Univariate analyses were carried out using Kaplan–Meier survival curves to assess the association of potential prognostic factors with the primary endpoints of overall survival (OS) rates and locoregional recurrence rates. Multivariate analyses were carried out using a Cox regression method.ResultsThe median total tumour volume (TTV), defined as the gross tumour volume plus the volume of involved nodes, was 103 cm3. Patients were divided into small and large tumour groups based on this median. OS rates at 1, 3 and 5 years for smaller volumes were 69%, 24% and 13% and for larger volumes 48%, 14% and 8%, respectively. On univariate survival analyses larger TTV was significantly associated with poorer OS (p = 0·019). The concurrent use of chemotherapy significantly improved survival (p = 0·026). Nodal involvement (p = 0·03) and Eastern Cooperative Oncology Group performance status (p < 0·001) were also significant independent prognostic factors of OS. On multivariate analysis TTV was strongly predictive of survival (p = 0·03; hazard ratio 1·702, 95% confidence interval 1·198–2·415). There was no association between nodal volume, tumour stages, overall stage, age, histology and radiation dose with any of the primary endpoints.ConclusionTTV is a significant prognostic factor in patients with advanced NSCLC treated by radical radiotherapy. In this cohort of patients TTV is more reliable at predicting survival than T stage and overall stage.
Background: Breast reconstruction (BR) has psychosocial and sexual well-being benefits in breast cancer (BC) patients that undergo mastectomy. However, this practice remains infrequent in many low-and middle-income countries as it is not usually covered by public health insurance schemes. This study aims to determine the prevalence and main predictors of BR among BC patients treated in a public center in Mexico.Methods: Medical records of women diagnosed with primary BC from 2009 to 2020 at a center in Monterrey, Mexico were reviewed. Patients who underwent a mastectomy and had at least a 2-year follow-up were included. Fisher's exact and logistic regression tests were employed to determine variable associations.Results: A total of 586 patients with a median age of 50 years (range 20-88) were included. The majority of patients were in a relationship (67%), postmenopausal (58%), and had a BMI 25 kg/m 2 (80%). Most common stages at diagnosis were II (44%) and III (41%). Overall, 54 (9%) received BR (41% immediate and 59% delayed). Predictors for undergoing BR were stages 0-I at diagnosis (OR 2.13, 95%CI 1.10-4.10; p¼0.024), age <40 years (OR 2.15, 95%CI 1.10-4.22; p¼0.026), premenopausal status (OR 2.62, 95%CI 1.45-4.73; p¼0.001), not receiving adjuvant radiotherapy (RT) (OR 2.34, 95%CI 1.30-4.21; p¼0.005), BMI <25 kg/m 2 (OR 2.62, 95%CI 1.44-4.74; p¼0.002), negative lymph node (LN) status (OR 2.47, p¼0.004), and bilateral mastectomy (OR 4.08, p<0.001). In a multivariate analysis, menopausal status, BMI, not receiving adjuvant RT, and bilateral mastectomy remained independent predictors for BR. Of note, no significant association was found between BR and type of LN surgery (axillary dissection v sentinel biopsy, p¼0.123).Conclusions: BR is one of the foremost strategies to improve BC survivors' quality of life. However, its uptake remains low in resource-constrained settings, possibly due to its high economic cost and information gaps among patients. Further studies are needed to identify other potential factors that influence BR uptake. The development of interventions that tackle the barriers limiting patients' adequate and equitable access to this procedure is urgently needed.Legal entity responsible for the study: The authors.
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