Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients EssentialsWe performed a pooled analysis of 926 patients with cancer-associated incidental pulmonary embolism (IPE). Vitamin K antagonists (VKA) are associated with a higher risk of major hemorrhage. Recurrence risk is comparable after subsegmental and more proximally localized IPE. Our results support low molecular weight heparins over VKA and similar management of subsegmental IPE.Summary. Background: Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on computed tomography scanning not performed for suspected PE. IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. We aimed to provide the best available evidence on IPE management. Methods: Incidence rates of symptomatic recurrent venous thromboembolism (VTE), major hemorrhage, and mortality during 6-month follow-up were pooled using individual patient data from studies identified by a systematic literature search. Subgroup analyses based on cancer stage, thrombus localization, and management were performed. Results: In 926 cancer patients with IPE from 11 cohorts, weighted pooled 6-month risks of recurrent VTE, major hemorrhage and mortality were 5.8% (95% confidence interval [CI] 3.7-8.3%), 4.7% (95% CI 3.0-6.8%), and 37% (95% CI 28-47%). VTE recurrence risk was comparable under low molecular weight heparins (LMWH) and vitamin K

BackgroundThis study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.MethodsA prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.ResultsSignificant differences in mean GTV volume were found between CT (11.9 cm3) and CT-MR (14.1 cm3), p < 0.006, CT-MR and PET (9.5 cm3), p < 0.0009, and MR (12.7 cm3) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm3) and oncologists (14.6 cm3) for all modalities (p = 0.001).ConclusionsThe use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.Trial registrationISRCTN Registry: ISRCTN34165059. Registered 2nd February 2015.

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gastrointestinal tract, thyroid, pituitary gland, liver and skin. Cutaneous adverse events include rash, pruritus, alopecia and vitiligo. A recent study including 1208 patients treated with ipilimumab showed an overall incidence of all-grade rash of 24Á3% 9 with no significant difference of frequency between melanoma and other malignancies, whereas pruritus may affect up to 31% of patients. 10 In the present case, we considered whether the TAD could be attributed to ipilimumab, based upon the following arguments: firstly, the absence of any other chronologically imputable treatment or any cause for abundant sweating; secondly, the complete resolution of the GD almost immediately after ipilimumab disruption, suggesting a direct, toxic (and not immunological) adverse effect and compatible with the ipilimumab half-life of 15 days. We assumed that this rapid clinical improvement was not imputable to the regression of the tumour because the metastatic disease progressed 2 months after the end of the treatment, although the GD did not relapse. Finally, the absence of exacerbation during the infusion period may be explained by the achievement of a stable plasmatic level at the time of the first infusion.To our knowledge, this is the first observation of TAD reported during ipilimumab treatment.