Solid Ectopic Cervical Thymus in Neonates With Thyroid Agenesis

We report a series of ectopic thymus glands as detected by sonography in infants with thyroid agenesis. The patients were children who underwent nuclear medicine and sonography for congenital hypothyroidism. Of the 12 patients with a diagnosis of thyroid agenesis over a 5‐year period, 4 (33%) were shown to have ectopic thymic tissue. Although a cervical ectopic thymus has been previously reported, there is very little discussion of it occurring in conjunction with thyroid agenesis. This case series highlights the importance of recognition of ectopic thymic tissue when examining for thyroid tissue in the setting of congenital hypothyroidism.     

Re-examining the role of adjuvant radiation therapy

Previously important roles for adjuvant radiotherapy (RT) in melanoma patients included improved regional control after resection of high-risk nodal disease, to reduce local recurrence for desmoplastic, and other subtypes of melanoma with neurotropism, reducing in-brain relapse of brain metastases after surgery and other situations on a case-by-case basis. This review evaluates the integration of adjuvant RT into clinical practice at this time of rapidly evolving knowledge and improving outcomes from effective systemic therapy.     

Long‐term outcomes for patients with limited stage follicular lymphoma

BACKGROUND:

Given the indolent behavior of follicular lymphoma (FL), it is controversial whether limited stage FL can be cured using radiotherapy (RT). Furthermore, the optimal RT field size is unclear. The authors of this report investigated the long‐term outcomes of patients with limited stage FL who received RT alone and studied the impact of reducing the RT field size from involved regional RT (IRRT) to involved node RT with margins up to 5 cm (INRT≤5 cm).

METHODS:

Eligible patients had limited stage, grade 1 through 3A FL diagnosed between 1986 and 2006 and treated were with curative‐intent RT alone. IRRT encompassed the involved lymph node group plus ≥1 adjacent, uninvolved lymph node group(s). INRT≤5 cm covered the involved lymph node(s) with margins ≤5 cm.

RESULTS:

In total, 237 patients were identified (median follow‐up, 7.3 years) and included 48% men, 54% aged >60 years, stage IA disease in 76% of patients, elevated lactate dehydrogenase (LDH) in 7% of patients, grade 3A tumors in 12% of patients, and lymph node size ≥5 cm in 19% of patients. The 2 RT groups were IRRT (142 patients; 60%) and INRT≤5 cm (95 patients; 40%). At 10 years, the progression‐free survival (PFS) rate was 49%, and the overall survival (OS) rate was 66%. Only 2 patients developed recurrent disease beyond 10 years. The most common pattern of first failure was a distant recurrence only, which developed in 38% of patients who received IRRT and in 32% of patients who received INRT≤5 cm. After INRT≤5 cm, 1% of patients had a regional‐only recurrence. Significant risk factors for PFS were lymph nodes ≥5 cm (P = .008) and male gender (P = .042). Risk factors for OS were age >60 years (P < .001), elevated LDH (P = .007), lymph nodes ≥5 cm (P = .016), and grade 3A tumors (P = .036). RT field size did not have an impact on PFS or OS.

CONCLUSIONS:

Disease recurrence after 10 years was uncommon in patients who had limited stage FL, suggesting that a cure is possible. Reducing RT fields to INRT≤5 cm did not compromise long‐term outcomes. Cancer 2010. © 2010 American Cancer Society.     

Are radiation oncologists aware of health literacy among people with cancer treated with radiotherapy?

Health literacy skills are important for people affected by cancer as they are exposed to complex treatment and follow‐up care information. This study aimed to (1) explore radiation oncologists' understandings and awareness of health literacy among patients with a reasonable command of English; (2) gain insight into oncologists' views regarding health literacy; and (3) identify techniques oncologists employ to communicate to different literacy populations. We conducted semi‐structured interviews with 26 radiation oncologists. Four key themes were identified: (1) identifying a patient's literacy level; (2) perceived impact of literacy; (3) challenges and strategies to communicating concepts and supporting decision‐making; and (4) suggested improvements to the health system. Participants described subjectively assessing a person's literacy level by monitoring the types of questions asked; analysing the language used; examining non‐verbal behaviour, and considering a person's socio‐economic situation. Participants reported the challenges of discussing the subtleties of cancer treatments with lower literacy groups such as the benefits and risks of treatment options and clinical trials, and tended to provide the basic facts to facilitate understanding. Radiation oncologists acknowledged the importance of health literacy in oncology, and employed a number of techniques to tailor their communication to different literacy populations. Further research is needed to address the challenges faced by oncologists when interacting with different literacy groups.     

Hepatic Vein Morphology

Objective. The purpose of this study was to evaluate the accuracy of a new sonographic marker for the diagnosis of cirrhosis using hepatic vein wall changes. Methods. A prospective pilot study evaluating 88 patients, 38 with cirrhosis and 50 with no evidence of liver disease, was undertaken. Hard copy sonograms of the hepatic veins were obtained and reviewed in a blinded fashion by 2 radiologists. The hepatic vein morphology was assessed by 3 parameters: hepatic vein wall straightness, uniformity of hepatic vein wall echogenicity, and visualization of a complete 1‐cm hepatic vein segment. The 3 parameters were compared to evaluate sensitivity and specificity for the diagnosis of cirrhosis. Interobserver and intraobserver errors for each parameter were also calculated with κ statistics to assess reproducibility. Results. There was a strong correlation between altered straightness and nonuniformity of hepatic vein wall echogenicity and cirrhosis. The straightness parameter had superior sensitivity of 97% (95% confidence interval [CI], 85%–100%) and specificity of 91% (95% CI, 78%–97%) for diagnosis of cirrhosis. Uniformity of hepatic vein wall echogenicity was the next most useful parameter, with sensitivity of 88% (95% CI, 73%–97%) and specificity of 86% (95% CI, 72%–95%). The continuous 1‐cm segment of the hepatic vein had sensitivity of 68% (95% CI, 49%–83%) and specificity of 91% (95% CI, 78%–97%). Hepatic vein evaluation was found to show both good intraobserver and interobserver error. Conclusions. Hepatic vein morphology on sonography, in particular, changes in the straightness and uniformity of hepatic vein wall echogenicity, is a new sign of cirrhosis, which may increase the overall accuracy of sonographic diagnosis of cirrhosis and which appears to have a moderately high degree of reproducibility.