Impact of Increasing Margin Around the Lumpectomy Cavity to Define the Planning Target Volume for 3D Conformal External Beam Accelerated Partial Breast Irradiation

The purpose of this study was to evaluate the dose to normal tissues as a function of increasing margins around the lumpectomy cavity in accelerated partial breast irradiation (APBI) using 3D-conformal radiotherapy (3DCRT). Eight patients with Stage 0-I breast cancer underwent treatment planning for 3DCRT APBI. The clinical target volume (CTV) was defined as a 15-mm expansion around the cavity limited by the chest wall and skin. Three planning target volumes (PTV1, PTV2, PTV3) were generated for each patient using a 0, 5-, and 10-mm expansion around the CTV, for a total margin of 15, 20, and 25 mm. Three treatment plans were generated for every patient using the 3 PTVs, and dose-volume analysis was performed for each plan. For each 5-mm increase in margin, the mean PTV:total breast volume ratio increased 10% and the relative increase in the mean ipsilateral breast dose was 15%. The mean volume of ipsilateral breast tissue receiving 75%, 50%, and 25% of the prescribed dose increased 6% to 7% for every 5 mm increase in PTV margin. Compared to lesions located in the upper outer quadrant, plans for medially located tumors revealed higher mean ipsilateral breast doses and 20% to 22% more ipsilateral breast tissue encompassed by the 25% IDL. The use of 3DCRT for APBI delivers higher doses to normal breast tissue as the PTV increases around the lumpectomy cavity. Efforts should be made to minimize the overall PTV when this technique is used. Ongoing studies will be necessary to determine the clinical relevance of these findings.     

Lower urinary tract symptoms in older adults undergoing hip arthroplasty: a feasibility study.

PURPOSE: We undertook a feasibility study to explore the prevalence of preoperative and postoperative lower urinary tract symptoms (LUTS) in older adults undergoing elective hip arthroplasty and to determine whether a larger prospective study was warranted. METHOD: Subjects awaiting elective hip arthroplasty were recruited preoperatively from an orthopedic office and preadmission clinic at 1 university-affiliated hospital. LUTS and related quality of life were measured prehospitalization and 6 weeks postoperatively using the American Urological Association Symptom Index and quality-of-life score. Postvoid residual urine and the 24-hour pad test were used to assess bladder emptying and continence status. RESULTS: Sixteen participants (9 males, 7 females, mean age 74 years) completed the study. Preoperatively, 15 participants reported at least 1 symptom and none had discussed these with a healthcare professional. The most common LUTS were nocturia, frequency, and urgency. Postoperatively, all reported symptoms, with 8 (53%) experiencing increased symptoms with a negative impact on quality of life for 3. Recruitment was a major barrier in conducting the study and would need to be taken into account in further studies of the topic. CONCLUSION: Despite recruitment issues, we suggest larger studies of LUTS in older adults undergoing surgery are warranted to further understand potential problems and risks in transition from hospital to home. Future studies should include identification of potential reasons for increased LUTS, including urinary tract infection.     

Differential etiology of posttraumatic stress disorder with conduct disorder and major depression in male veterans.

BACKGROUND: Epidemiologic studies reveal that posttraumatic stress disorder (PTSD) is highly comorbid with both conduct disorder and major depression in men. The genetic and environmental etiology of this comorbidity has not been examined. METHODS: Data were analyzed from 6744 middle-aged male-male monozygotic and dizygotic twins from the Vietnam Era Twin Registry. Conduct disorder, major depression, and PTSD were assessed via telephone interview using the Diagnostic Interview Schedule for the DSM-III-R in 1992. Structural equation modeling was used to estimate additive genetic, shared environmental, and individual-specific environmental effects common and specific to conduct disorder, major depression, and PTSD. RESULTS: The association between conduct disorder and PTSD was explained primarily by common shared environmental influences; these explained 10% (95% confidence interval: 6%-17%) of the variance in PTSD. The association between major depression and PTSD was largely explained by common genetic influences; these explained 19% (95% confidence interval: 11%-26%) of the variance in PTSD. CONCLUSIONS: Our findings suggest that different etiologic mechanisms explain the association of conduct disorder and major depression with PTSD in male veterans. If replicated in other populations, results suggest research aimed at identifying specific genetic and environmental factors that influence PTSD may benefit from starting with those that have been more consistently and strongly associated with major depression and conduct disorder.