局部晚期高危乳腺癌根治术后辅助低分割放疗的临床应用

目的：探索在局部晚期高危乳腺癌根治术后辅助放疗采用不同放疗分割方式对无进展生存期（PFS）的影响。方法：回顾性分析香港大学深圳医院2015年6月至2021年5月腋窝淋巴结阳性N3期、接受过乳房根治性切除术且接受术后辅助放疗的局部晚期高危乳腺癌患者的资料,患者的放疗分割方式采用低分割放疗及常规分割放疗,分析两种放疗方式对患者PFS的影响,用Kaplan–Meier法绘制患者生存曲线,并比较PFS差异;单因素和多因素Cox风险比例模型研究两种不同放疗分割方式对PFS的影响。结果：共纳入患者134例,患者中位年龄45岁,其中接受低分割放疗95例,接受常规分割放疗39例。中位随访时间为52个月,Cox回归分析显示：T分期是PFS的影响因素（P <0.05）,放疗分割方式并非PFS的影响因素（P=0.160）,矫正混杂因素T分期后,放疗分割方式亦非PFS的影响因素（P=0.069）。结论：局部晚期浸润性乳腺癌根治术后辅助放疗在本中心单一机构的临床实践中,低分割放疗与常规分割放疗疗效相似,患者PFS差异无统计学意义。低分割放疗能明显缩短患者的治疗周期,实现在有限的时间和设备资源条件下,为更多...     

缓释型氟尿嘧啶植入剂应用于乳腺癌改良根治的安全性

背景：如何寻找更好的药物剂型、给药途径,使高浓度的药物直接作用于局部,并提高药物对局部靶组织的选择性、延长药物作用时间,对预防乳腺癌局部复发有重要意义。目的：探索在乳腺癌改良根治术中应用氟尿嘧啶植入剂的临床安全性,探寻预防乳腺癌局部复发的新途径。方法：63例乳腺癌改良根治术患者,TNM分期：Ⅰ+Ⅱ期35例,Ⅲ期28例,随机分为植入剂组32例及对照组31例,植入剂组在肿瘤下方,腋窝、锁骨下血管区域、胸大小肌之间多点喷撒氟尿嘧啶植入剂,总剂量为600 mg,每点处小于100 mg,观察应用植入剂后,切口有无感染裂开,8 d后的皮下积液情况,皮瓣坏死、患肢水肿、拆线天数及血红、白细胞、肝肾功能情况。结果与结论：植入剂组与对照组在切口感染裂开、皮下积液量、患肢水肿、拆线天数及血红细胞计数等方面差异无显著性意义(P > 0.05),两组治疗后,血白细胞计数、谷丙转氨酶、肌酐均较治疗前有明显增加(P < 0.05),但是两组之间差异无显著性意义(P > 0.05)。结果提示乳腺癌改良根治术中应用氟尿嘧啶植入剂是安全可靠的,是乳腺癌术后局部化疗的有效途径。关键词：乳腺癌;改良根治术;氟尿嘧啶植入剂;安全性;缓释材料;药物控释系统及其载体材料doi:10.3969/j.issn.1673-8225.2010.08.034     

Constipation Severity and Quality of Life among Patients with Cancer Who Received Prophylactic Laxatives: Quasi-Experimental Study

Background: Prophylactic laxatives were associated with decreasing the incidence of Opioid-induced constipation among patients with cancer. This study aims to evaluate the effectiveness of early prophylactic laxatives therapy on the severity of constipation and quality of life among patients with cancer receiving opioids. Methods: Using a quasi-experimental design with 64 patients assigned to control group and 66 patients assigned to intervention group. The final sample was composed from 112 patients (57 in control group and 55 in intervention group), who were selected from an oncology clinic. Patients in the intervention group have received prophylactical laxatives The intervention included an oral colonic stimulant laxative (i.e., Bisacodyl, Dose= 3 tab/ day and/or Senna 6.8 mg twice daily) and an oral colonic osmotic laxative (i.e., Lactulose, Dose = 15 ml three times per day). Patients in the control group continue to receive their routine care without laxatives. Results: Patients in the intervention group have reported a significant reduction in the severity of constipation symptoms at eight weeks post the intervention (p < 0.001). Furthermore, the patients in the intervention group have revealed a significant improvement in their quality of life (QoL) (p< 0.001). Conclusions: Patients with cancer need to use the first line of laxatives as prophylactic alongside with opioids to minimize the severity of Opioid-induced constipation symptoms and to enhance the QoL.     

Retrospective analysis of bleeding events after central venous catheter placement in thrombotic thrombocytopenic purpura

BackgroundThrombotic thrombocytopenic purpura (TTP) is a thrombotic disorder caused by severe deficiency of ADAMTS13. Platelets are transfused prophylactically in non-TTP patients for central venous catheter (CVC) with a count <20 × 10⁹/L to prevent bleeding. However, transfusing platelets in TTP prior to CVC placement remains controversial due to concern for arterial thrombosis and mortality. At our center, platelet transfusion is contraindicated in TTP, therefore, we analyzed data for bleeding complications following CVC placement.Study Design and Methods95 acute episodes of TTP were identified. Twenty-six episodes were excluded for insufficient documentation or no CVC placement. The charts of 69 remaining episodes were reviewed.ResultsOf 69 TTP episodes, nine (13 %) had bleeding after a CVC placement. Of these, seven bleeds were minor, and the two were major related to the technical issues during femoral venous access causing arterial bleeds. Median platelet count before the CVC placement among those experiencing bleeding complications was 12 × 10⁹/L (range 3–44) as compared to median count of 15 × 10⁹/L (range 4–257) in those who did not bleed (p = 0.258). Among 44 episodes with a platelet count <20 × 10⁹/L, seven (16 %) had bleeds.ConclusionMajor bleeding complications following CVC placement in TTP is uncommon and most likely related to technical challenges. Median platelet count was similar in patients who bled versus those who did not, suggesting that platelet transfusion is unnecessary to correct platelet count prior to a CVC placement in TTP.     

Prophylactic central lymph node dissection informs the decision of radioactive iodine ablation in papillary thyroid cancer

BackgroundProphylactic central lymph node dissection (CLND) in papillary thyroid cancer (PTC) is controversial. We aimed to investigate if prophylactic CLND aids risk stratification and contributes to the decision for postoperative RAI ablation.MethodsPatients undergoing thyroidectomy for PTC and prophylactic CLND were identified from an endocrine surgical unit database. Pathology reports where reviewed for number and size of lymph nodes and patients stratified by risk according to the ATA guidelines.Results426 patients were identified with PTC ≤4 cm and prophylactic CLND. 96 patients (23%) had central lymph node metastasis (CLNM) that qualified them for the intermediate risk group. In 17 patients (4%), the CLNM data led to upgrading independently of other histopathological characteristics. Correcting for multiple variables, CLNM was an independent factor contributing to RAI treatment.ConclusionProphylactic CLND provides information to aid the selection of RAI ablation independent of primary cancer histology for risk stratification in 4% of patients. This benefit should be carefully balanced with the risk of CLND and patient treatment choice when deciding on management of PTC ≤4 cm.     

Residual breast tissue after robot-assisted nipple sparing mastectomy

IntroductionWhile the long-term oncologic safety of robot-assisted nipple sparing mastectomy (RNSM) remains to be elucidated, histologically detected residual breast tissue (RBT) can be a surrogate for oncologically sound mastectomy. The objective of this study is to determine the presence of RBT after RNSM.MethodsBetween August 2019–January 2020, we completed 5 cadaveric RNSMs. Full thickness biopsies from the mastectomy skin flap were obtained from predefined locations radially around the mastectomy skin envelop and nipple areolar complex to histologically evaluate for RBT.ResultsThe first case was not technically feasible due to inability to obtain adequate insufflation. Five mastectomy flaps were analyzable. The average mastectomy flap thickness was 2.3 mm (range 2–3 mm) and the average specimen weight was 382.72 g (range 146.9–558.3 g). Of 70 total biopsies, RBT was detected in 11 (15.7%) biopsies. Most common location for RBT was in the nipple-areolar complex, with no RBT detected from the peripheral skin flaps.ConclusionsIn this cadaveric study, RNSM is feasible leaving minimal RBT on the mastectomy flap. The most common location for RBT is in the periareolar location consistent with previous published findings after open NSM. Clinical studies are underway to evaluate the safety of RNSM.