The development of audio-visual materials to prepare patients for medical procedures: an oncology application

This paper describes a systematic process for the development of educational audio-visual materials that are designed to prepare patients for potentially threatening procedures. Literature relating to the preparation of patients for potentially threatening medical procedures, psychological theory, theory of diffusion of innovations and patient information was examined. Four key principles were identified as being important: (1) stakeholder consultation, (2) provision of information to prepare patients for the medical procedure, (3) evidence-based content, and (4) promotion of patient confidence. These principles are described along with an example of the development of an audio-visual resource to prepare patients for chemotherapy treatment. Using this example, practical strategies for the application of each of the principles are described. The principles and strategies described may provide a practical, evidence-based guide to the development of other types of patient audio-visual materials.     

Newer medical therapies for metastatic soft tissue sarcoma

Introduction: Metastatic/advanced soft tissue sarcoma has a poor prognosis conventionally, treatment options have been limited. In recent years, this area has been a rich ground for research with many new drugs being approved and several more in the pipeline. With multiple new treatment options available, it is vital to keep up pace with this rapidly changing field.

Areas covered: Recent data regarding use of novel agents in advanced soft tissue sarcoma is reviewed with a focus on clinical applicability. The goal is to guide the clinician into choosing appropriate lines of therapy for the individual patient in light of recent availability of multiple new treatment options.

Expert commentary: Patients with advanced soft tissue sarcoma can expect to receive several lines of therapy in the modern era. Tumor histology should ideally guide the choice of therapy. The new FDA approved second line drugs viz, trabectedin, pazopanib and eribulin should be considered first after failure of doxorubicin-based chemotherapy. Additional options have become available, such as antiangiogenic agents, mTOR inhibitors, and several new molecules targeting specific oncogenic pathways. All these agents have a role in treating soft tissue sarcoma, and careful individualization of therapy can help achieve optimal outcomes in these challenging patients.     

Neurological complications of medical anti-cancer therapies

This review describes the features of central and peripheral neurological disorders caused by anti-cancer chemotherapy and supportive medications, such as antiepileptic drugs, glucocorticosteroids and opioids, frequently used in cancer patients. Diffuse encephalopathy with or without epileptic seizures, cerebellar disorders and aseptic meningitis may occur after systemic administration of conventional drug doses, but their incidence is much higher when either high-dose chemotherapy, or intrathecal or intracarotid administration is used. Spinal cord and/or spinal root lesions have been reported after intrathecal administration of methotrexate or cytosinearabinoside. Anti-cancer chemotherapy is the leading cause of peripheral neuropathy in cancer patients. The main culprits are vinca alkaloids, platinum derivatives and taxanes. Anti-cancer chemotherapy has no significant toxic effect on muscle tissue, but heavy administration of glucocorticosteroids is a common cause of disabling, predominantly pelvic, muscle atrophy.     

Complementary and alternative medical therapies for children with cancer

Complementary and alternative medical therapies (CAM) are treatments that generally fall outside of the mainstream of conventional medicine. CAM therapies are used by 31-84% of children with cancer, including many children enrolled on clinical trials. CAM therapies are often used for the treatment of side-effects of cancer or cancer therapy, and only rarely as an alternative to conventional therapy. Regulation of CAM therapies varies worldwide, and many therapies have not been subject to scientifically conducted analyses. Adverse events have been described, especially from the contamination of herbs. Only rare reports of interactions of CAM therapies with conventional anticancer treatments have been reported. Several research studies of CAM in children with cancer are underway. In the interim, non-pharmacological therapies such as mind-body medicine, manipulative and body-based therapies and energy therapies may be used for supportive therapy. Research is needed before biologically based CAM therapies may be recommended in conjunction with conventional therapy.     

Comparison of calibration procedures for 192Ir high-dose-rate brachytherapy sources

PURPOSE: To compare the efficacy of different calibration procedures for 192Ir high-dose-rate (HDR) brachytherapy sources and to determine their suitability in clinical practice. In addition the manufacturer's calibration is compared with our experimental measurements so that the accuracy of the source strength on the manufacturer certificate which is supplied with each new 192Ir source can be accessed. METHODS AND MATERIALS: We compared three types of calibration system: well-type chambers (HDR-1000 and SDS), cylindrical phantom, and plate phantom. The total number of measurements we obtained was 365. The number of sources used for the calibration procedure comparison was 20 and the number used for comparison with the manufacturer's calibration was 46. This study was made during the period 1989-1997. Also, Physikalisch-Technische Bundesanstalt (PTB) calibrated one of our sources using their PTB protocol so that the results could be compared with our own. RESULTS: The sensitivity of each system on scattering from the room walls was studied. It was found that different minimum lateral distances from the walls were required for the different systems tested: 15 cm and 25 cm for the well-type chambers, 75 cm for the cylindrical phantom, and 13 cm for the plate phantom. The minimum thickness required to reach phantom scattering saturation for the plate phantom setup is 24 cm. The influence of the applicator material used in the calibration setup was found to be 1.7% for the stainless steel dosimetry applicator compared to the plastic 5F applicator. The accuracy of source positioning within the applicator can lead to dosimetric errors of +/-1.2% for the radial distance of 8.0 cm used with both solid phantoms. The change in the response for both well-type chambers was only 0.1% for changes in the source position within +/-7.5 mm around the response peak. Good agreement was found between all dosimetry systems included in our study. Taking the HDR-1000 well-type chamber results as a reference, we observed percentage root mean square (RMS) values of 0.11% for the SDS well-type chamber, 0.44% for the cylindrical, and 0.60% for the plate phantom setup. A comparison of our results using the cylindrical phantom with those of the manufacturer showed a percentage RMS value of 3.3% with a percentage fractional error range of -13.0% to +6.0%. The comparison of our calibration results with those of PTB gave deviations less than 0.4% for all systems. CONCLUSIONS: Our results have shown that with careful use of all calibration system protocols an accurate determination of source strength can be obtained. However, the manufacturer's calibration is not accurate enough on its own, and it should be mandatory for clinics to always measure the source strength of newly delivered 192Ir brachytherapy sources. The influence of the applicator material, metal or plastic, should always be taken into account.     

三种Feulgen染色方法的比较

目的探索一种快速的Feulgen染色方法,并尝试其在细胞核DNA含量分析中的应用。方法选取十只健康小白鼠的肝细胞涂片,每只小白鼠的肝细胞涂片分成三组,采用快速Feulgen染色法、改良Feulgen染色法、传统Feulgen染色法对这三组分别染色,用TIGER细胞图像分析仪测量肝细胞涂片内单个完整肝细胞核的DNA含量,比较各组染色效果和肝细胞核DNA含量的测量结果。结果应用快速Feulgen染色法,获得了满意的效果,细胞核染色深,结构清晰,背景着色淡,而所需染色时间仅为15分钟;同一种方法染色的不同小鼠肝细胞涂片,相同DNA含量倍体肝细胞核的DNA含量均值的变异系数(CV)<10%,CV(快速)IOD(改良)>IOD(传统);各组2、4、8倍体肝细胞核DNA含量间的比值均接近2或4;结论此种快速Feulgen染色方法优于其他两种方法,可应用于图像分析系统对细胞核DNA含量与倍体的测量和分析。     

A discussion on surgical procedures to palliate symptoms for home medical care

In the field of digestive tract surgery, QOL can be significantly decreased in patients who experience recurrence or metastasis of a cancer, not only by digestive tract disorders that prevent the patient from taking a meal, but also by installation of gastric or ileus tubes. For such patients, surgical procedures aimed to palliate their symptoms are necessary, rather than radical surgeries. We examined 24 cases at our department, for which operations were performed with the aim of palliating their symptoms, during the 4-year period from October 2001 to December 2005. Sixteen (89%) out of 18 symptomatic cases (i.e. patients who could not take a meal, or who had undergone tracheal intubation) exhibited confirmed improvement in their symptoms after the operations. On the other hand, we also experienced one case in which installation of an ileus tube was necessary after the operation (1 case, 5.5%). Five patients (20.9%) died after the operation, before they were discharged from the hospital. For such patients, additional minimally invasive procedures should have been taken into consideration.     

晚期鼻咽癌RapidArc与固定野调强放疗的比较研究

  目的  近年RapidArc的临床应用已引起越来越多的关注, 本研究比较RapidArc与固定野调强放射治疗(IMRT)两种放疗技术在晚期鼻咽癌治疗计划中的差异。  方法  随机选取10例晚期鼻咽癌患者, 采用RapidArc与IMRT两种技术进行计划设计与剂量验证, 比较计划的靶区剂量、危及器官与正常组织剂量、机器跳数、治疗时间与剂量验证结果。  结果  两种计划的剂量分布基本一致, 均能提供足够的靶区剂量。RapidArc的PTVnx最小剂量, PTVnd、PTV60、喉、腮腺的平均剂量低于IMRT, PTV60的HI值高于IMRT, 机器跳数比IMRT减少约58%, 治疗时间减少约70%。以3%/3mm为界, RapidArc验证的γ指数通过率为(98.75±0.50)%, IMRT的通过率为(98.86±0.67)%。  结论  两种放疗技术均能够满足临床治疗需要, 剂量验证结果能够较好的符合计划计算结果。RapidArc比IMRT有着更多的优势, 不仅可以减少机器跳数, 缩短治疗时间, 而且可以减少喉、腮腺的受照剂量。      

Absolute benefits of medical therapies in phase III clinical trials for breast and colorectal cancer

BackgroundPhase III randomized clinical trials (RCTs) have become larger and are powered to detect small absolute benefits. Temporal changes in absolute benefits of experimental medical therapies reported in RCTs are unknown.MethodsWe identified all RCTs with sample size ≥200 evaluating experimental medical therapies for breast and colorectal cancer published from 1975 to 2007. We assessed changes over three decades in absolute differences in time-to-event end points between experimental and control arms by (i) the usual method (i.e. at one point) and (ii) as the area between time-to-event curves up to a predefined time.ResultsWe identified 236 eligible RCTs of which 57% (N = 135) evaluated adjuvant treatments. Experimental treatments became more often compared with active treatments (48% versus 59% versus 81%; P < 0.0001). Median absolute benefits of experimental adjuvant treatments decreased but outcomes in control arms improved with time. For RCTs evaluating metastatic disease, there were no changes in absolute benefit over time but incremental monthly costs of new approved treatments increased with time by 100-fold (P < 0.0001).ConclusionIn RCTs of breast and colorectal cancer, new effective adjuvant treatments show decreasing absolute benefit, while new treatments of metastatic disease show unchanging levels of benefit at rapidly escalating costs.     

Comparison of heat delivery systems for hyperthermia treatment of psoriasis

Psoriasis is a skin disease characterized by accelerated growth and loss of the normal maturation pattern of the epidermis. It represents a model to study the application of localized heating to a hyperproliferative but benign superficial skin disease. Thermal distributions in psoriatic plaques treated with ultrasound, water contact and infrared systems are presented. The concepts of Standard Thermal Dose and Equivalent Thermal Dose are introduced to quantify the total biological effect to tissue for a particular time and temperature during a hyperthermia treatment session.     

Adjuvant psychological therapy for cancer patients: putting it on the same footing as adjunctive medical therapies

A comparison is made between the models guiding the administration of adjuvant material remedies, such as chemotherapy, and 'adjunctive psychological therapy' (APT), in the treatment of cancer. It is argued that patients would benefit if APT were supplied subject to the same indications as adjuvant chemotherapy.     

Comparison the standard therapies of gastric cancer in Japan with those in the West

We compare Japanese practice guidelines for gastric cancer with those published from National Comprehensive Cancer Network (NCCN). In surgery, D1 dissection is referred as standard in NCCN, because mortality of D2 dissection was higher than that of D1 (10% vs 4%). However, Japanese investigators show lower mortality rate (0.8%) of D2 dissection, so D2 dissection is referred as standard for stage II/III disease in Japan. Chemoradiotherapy is chosen for residual disease or unresectable disease (M0) in NCCN, but these categories are required D2 dissection or extensive resection in Japan. Because Japanese D2 dissection has better optimized survival rate than chemoradiotherapy,chemoradiotherapy will not be introduced to Japan.In chemotherapy, ECF or taxanes (e.g., DCF) is referred as a prior therapy in NCCN, but 5-FU contain regimen (e.g., FP, LV/5-FU, S-1, or S-1/CDDP) as a prior therapy in Japan. Both ECF and DCF are too toxic regimen for Japanese patient to use. Difference of race seem to be relevant to difference of mortality or toxicities. From the results of ACTS-GC, we think that adjuvant chemotherapy is referred as standard in Japan. Future, results of JCOG 9912 and many other trials will be coming soon, so the guidelines will be changed.     

Pharmacodiagnostics and targeted therapies - a rational approach for individualizing medical anticancer therapy in breast cancer

The selection of therapy for a particular breast cancer patient is traditionally based on average results from randomized clinical trials. Rational pharmacotherapy is in essence about selecting the right drug(s) for the right patient, and in order to guide this selection process pharmacodiagnostic tests are indispensable. A number of tests have been developed or are under development for targeted therapies, such as antiestrogens, human epidermal growth factor receptor 2 inhibitors, and topoisomerase inhibitors. Based on a biopsy from the tumor, the tests are able to identify patients with a high probability to benefit from these therapies. The detection of the predictive biomarkers is based on different technologies, such as immunohistochemistry, fluorescence in situ hybridization, and chromogenic in situ hybridization. Pharmacodiagnostic tests will play an important role in the further development of targeted therapies and may be seen as a prerequisite for the introduction of individualized medicine in oncology.     

巨块型子宫颈癌治疗方法比较

目的 比较巨块型或局部晚期子宫颈癌几种治疗方法的疗效、并发症及经济性.方法 1991年1月至1993年12月收治的80例巨块型子宫颈癌随机分组(1组、2组)及1994年1月至1997年12月收治的96例巨块型子宫颈癌随机分组(3组、4组).1组40例接受动脉介入化疗+放射治疗;2组40例接受静脉化疗+放射治疗;3组48例接受激光+放射治疗;4组48例接受增加腔内治疗次数(消瘤量).结果 四组3年生存率分别为75.0%、72.5%、77.1%、75.0%,两两比较差异均无统计学意义(P＞0.05).5年生存率分别为65.0%、62.5%、66.7%、64.6%,两两比较差异均无统计学意义(P＞0.05).放射性直肠炎(便血)发生率分别为12.5%、10.0%、10.4%、27.1%,1组、2组、3组分别与4组比较,差异均有统计学意义(P＜0.05),其他各组间比较,差异均无统计学意义(P＞0.05).放射性膀胱炎(尿血)发生率为12.5%、15.0%、8.3%、22.9%.1组、2组、3组分别与4组比较,差异均有统计学意义(P＜0.05),其他各组间比较,差异均无统计学意义(P＞0.05).治疗费用(以人民币计算,常规放射治疗花费之外):1组平均14 000元,2组4000元,3组800元,4组1000元.结论 激光+放射治疗是治疗巨块型或局部晚期子宫颈癌的有效方法,患者不良反应发生率低,疗程较短,花费少.静脉化疗与动脉化疗远期疗效相近,但所需设备及费用较低,在没有激光设备时可以推广.     

晚期原发性肝癌治疗的研究进展

原发性肝癌位居全球最常见恶性肿瘤的第五位,在癌症相关死亡原因中排名第三位.原发性肝癌治疗方法的选择很大程度上取决于肝脏功能,肿瘤大小,是否存在转移灶和血管侵犯.目前,原发性肝癌的根治方法包括肝切除术和肝移植手术,但是很多患者确诊时已进入晚期,失去了治愈的机会.全身系统性治疗对于晚期原发性肝癌的患者变得尤为重要,其中包括:分子靶向治疗、全身系统性化疗和免疫治疗.本文就近年来晚期原发性肝癌治疗的研究进展作一综述.     

Medical complications and medical legal pitfalls concerning interventional radiological procedures on the breast]

Radiological interventional procedures on the breast are still work in progress. Initiation of percutaneous macrobiopsy techniques such as stereotactic or ultrasound-guided core biopsy, mammotomy or Abbi Site-Select procedures allows the physician to expect a high accuracy for the diagnosis of non palpable suspected breast abnormalities, thus eliminating the need for at least half of the surgical biopsies done for this indication. Furthermore, the absence of any lasting post-procedural changes on follow-up mammography contrasts with the scarring associated with traditional surgical open biopsy and obviates confusion in subsequent mammographic interpretation. Recently, development of percutaneous radiofrequency or cryotherapy ablation of breast cancer has been related. All these cost-saving procedures lead to medical and potential medical legal pitfalls that will be discussed.