Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review.

BACKGROUND: Brain metastases are the most common intracranial tumour in adults, estimated to occur in up to 40% of patients with cancer. Despite being used in clinical practice for 50 years, the effectiveness of whole brain radiotherapy for the treatment of brain metastases remains uncertain. OBJECTIVES: To assess the effectiveness of whole brain radiotherapy (WBRT) on survival and quality of life. To identify whether patient performance status, number of brain metastases, extent of extracranial disease and primary site of cancer are important effect modifiers. DESIGN: Systematic literature review. METHODS: Electronic searches of four databases, augmented by hand searches of the most frequently encountered journal and assessment of the reference lists of consensus statements and all retrieved papers. Included papers underwent structured data extraction, assessment and qualitative synthesis. RESULTS: Thirty-two primary studies were included, with a range of study designs, methodological quality, pre-treatment variables, interventions and outcome measures. From the limited evidence available, survival appeared to increase when patients were selected by performance status (survival increasing from approximately three to seven months in high performance status groups, as defined by Karnofsky performance status or Recursive Partitioning Analysis classification). The evidence suggests no survival benefit when patients with poor performance status were treated with whole brain radiotherapy. No studies undertook direct measurement of patients' quality of life. Surrogate measures of patients' quality of life, such as improvement in neurological function or improvement/maintenance of KPS > or =70, produced response rates ranging from 7 to 90%. CONCLUSION: The heterogeneity of study designs, quality and outcomes necessitates caution in interpreting the review findings. WBRT appears to be of benefit in higher performance status patients but not in low performance status patients. This suggests a basis for current practice, however further robust trial evidence is required.

Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations.

PURPOSE: To prospectively compare full-field digital mammography (FFDM) with screen-film mammography (SFM) for cancer detection in a screening population. MATERIALS AND METHODS: At two institutions, 4,945 FFDM examinations were performed in women aged 40 years and older presenting for SFM. Two views of each breast were acquired with each modality. SFM and FFDM images were interpreted independently. Findings detected with either SFM or FFDM were evaluated with additional imaging and, if warranted, biopsy. RESULTS: Patients in the study underwent 152 biopsies, which resulted in the diagnosis of 35 breast cancers. Twenty-two cancers were detected with SFM and 21 with FFDM. Four were interval cancers that became palpable within 1 year of screening and were considered false-negative findings with both modalities. The difference in cancer detection rate was not significant. FFDM had a significantly lower recall rate (11.5%; 568 of 4,945) than SFM (13.8%; 685 of 4,945) (P <.001, McNemar chi(2) model; P <.03, generalized estimating equations model). The positive biopsy rate for findings detected with FFDM (30%; 21 of 69) was higher than that for findings detected with SFM (19%; 22 of 114), but this difference was not significant. CONCLUSION: No difference in cancer detection rate has yet been observed between FFDM and SFM. FFDM has so far led to fewer recalls than SFM.

A complication involving a braided hook-wire localization device.

At the authors' institution, needle localization of breast lesions with a braided hook wire involves the wire being cut 1-2 cm from the point of entry before dissection, to avoid contamination of the sterile field with the nonsterile portion of wire. During dissection, the wire is brought through the skin into the area of dissection. In one patient, fragments of wire filaments were left within the breast. Braided hook wires must be cut cleanly, the cut surface should be wiped before dissection, and the surgical area should be cleansed before closure.

CT sialography: utilising acinar filling.

The technique of computed tomographic sialography (CTS) has been demonstrated to be valuable in the diagnosis of masses of the major salivary glands. Forty-one CT sialograms were performed in 35 patients using acinar glandular filling with oily contrast material. Twenty-two mass lesions and seven cases of inflammatory disease were identified. There were two instances of mild parotitis following the procedure. CTS performed with this technique was found to be a safe, accurate method for evaluating salivary gland masses.

Sonographic pseudoasymmetry of the prenatal cerebral hemispheres.

The ultrasonographic image of the fetal head at the appropriate level for determination of the biparietal diameter reveals an apparent asymmetry of the cerebral hemispheres. This was confirmed and analyzed in 49 sequential fetuses who had no neurologic deficits at birth and in the autopsy specimen of an 8-month-old infant without any anatomic abnormalities of the head. In the hemisphere farthest from the transducer, a crescent-shaped echo-poor region was visualized abutting the calvarium. This resembles an abnormal fluid collection but represents normal anatomy. High-amplitude reflections were observed on the medial side of the crescent and were produced by the combination of the sylvian fissure and the choroid plexus of the lateral ventricle. The fine echo pattern of the near hemisphere, which appeared to represent normal anatomy, was artifactual. The cerebral asymmetry seen by conventional ultrasonographic imaging after the 15th gestational week should not suggest an underlying pathologic process. The studies suggest that a higher-quality examination of the near hemisphere of the fetal cranium can be performed with properly focused transducers.