Surgical risk score predicts suboptimal debulking or a major perioperative complication in patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer.

BACKGROUND: Patients who present with an advanced ovarian cancer are typically treated with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery. The accurate pretreatment identification of patients best suited for PDS versus NAC is challenging. A paradigm for selecting one approach over the other could improve patient outcomes. In this study, we developed a prediction model for "successful surgery" (defined as optimal residual disease and no major perioperative complication) in patients who underwent PDS. PATIENTS: Preoperative clinical characteristics, laboratory values, computed tomography findings, and surgical outcomes of 106 consecutive medically fit patients with advanced ovarian, tubal, or peritoneal cancer were reviewed. Preoperative predictors of suboptimal residual disease and major perioperative complications were determined using regression analysis. A surgical risk score (SRS) that minimized the false-negative rate (ie, likelihood of incorrectly predicting successful surgery) was constructed. RESULTS: Sixty (57%) of the 106 patients were optimally cytoreduced. Fifty-six "radical procedures" were performed, and there were a total of 24 major perioperative complications. Diffuse peritoneal studding (P < 0.0001), para-aortic lymphadenopathy (P < 0.0001), and mesenteric involvement (Mes, P = 0.006) were associated with suboptimal (>1 cm) residual disease. Low albumin (P = 0.04) and splenic disease (spleen, P = 0.02) were the only 2 parameters associated with a higher risk of a major perioperative complication. The median SRSs of patients who had successful and "unsuccessful surgery" were 1 (0-4) and 3 (0-6), respectively. The false-negative rate of the SRS was only 7%. CONCLUSIONS: We developed a model that incorporated complications, in addition to residual disease status, into predicting surgical outcome for medically fit patients with advanced ovarian cancer. The SRS might be useful in determining the initial treatment strategy (ie, PDS vs NAC) for these patients. The accuracy of the SRS needs to be validated in a prospective manner.

The effect of the eye's surface topography on the total irradiance of ultraviolet radiation on the inner canthus.

Basal cell carcinoma is the most commonly occurring skin cancer in sub tropical climates. The link between ultraviolet radiation (UVR) and basal cell carcinomas (BCC) is strong. Numerous studies have investigated the spatial distribution of BCCs over the head and neck region and the relative UVR dose, with little or no correlation found between the UVR dose and occurrence rates. This is particularly noted in the inner canthus region. The inner canthus' field of view is restricted by the eye brow ridge, eye orbit and the cheek bone. Yet, the occurrence rate here of BCC's when compared to other regions that are more directly exposed to the environment is significantly higher. A possible causal effect for the increase in occurrence rate in this region is the focussed reflection of UVR from the tear film surface associated with the eye not previously considered in earlier studies. This paper investigates the potential for the surface topography of the eye to reflect focussed radiation towards the inner canthus using a ray tracing programme where the analysis is conducted at a cellular level. Defined hot spots, or striations, of increased irradiation were evidenced across the surface of the inner canthus. This increase in irradiation was not observed with macroscopic detectors which also possibly explain why this increased dose has not previously been detected during environmental measurements with large detectors on manikins or humans.