Differences in survival between Maori and New Zealand Europeans with prostate cancer.

This study aims to examine the survival disparity between Maori men and New Zealand (NZ) Europeans diagnosed with prostate cancer. We identified men aged 40+ years in the Midland Cancer Network region registered with prostate cancer in 2007-2010 in the Cancer Registry. Data were extracted from patient notes of all Maori men and a sample of NZ Europeans. The survival disparity between Maori men and Europeans was estimated by the Kaplan-Meier method and Cox proportional-hazards regression models after adjusting for other factors. This study included 535 men with prostate cancer (135 Maori men and 400 Europeans). The 5-year cancer-specific survival was 98.6% for men diagnosed with localised cancer, 88.8% for locally advanced disease and 19.1% for metastatic cancer. The all-cause survival and the cancer-specific survival were both significantly poorer for Maori men than for NZ Europeans (log rank test: P = 0.004, 0.006 respectively). The hazard ratio of cancer-specific survival for Maori men was 2.01 (95% CI: 1.21-3.36) compared with NZ Europeans. Maori men with prostate cancer had poorer all-cause survival and cancer-specific survival than NZ Europeans. Maori men were at risk of having more advanced disease at diagnosis, which explains most of the survival inequity between Maori men and NZ Europeans.

The effect of high dose rate brachytherapy in combination with external beam radiotherapy on men's health-related quality of life and sexual function over a 2 year time span.

AIM: To investigate changes in health-related quality of life and sexual function in men after high dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT), with or without androgen deprivation therapy, for localised prostate cancer. MATERIALS AND METHODS: Eligible men who had undergone HDR brachytherapy/EBRT for their prostate cancer completed questionnaires before any treatment (baseline) and at 3 monthly intervals. The European Organization for Research and Treatment of Cancer (EORTC) C30 quality of life measure (QLQ-C30), the PR25 prostate-specific supplement and the International Index of Erectile Function-Short Form (IIEF-SF) were completed. An analysis of changes from baseline to 2 years, for the 87 men who completed surveys, was carried out. RESULTS: The mean EORTC QLQ-C30 quality of life scores, urinary, bowel and sexual symptoms had all improved. However, improvements did not return men to baseline levels at 2 years. Sexual function as measured by both scales was least likely to recover. There were no differences due to androgen deprivation therapy. Minimally important differences were still reported by men at 2 years as follows: urinary (36%), bowel (24%), hormone treatment side-effects (40%), IIEF-SF (55%). Discrepancies between mean and minimally important differences changes are explained by some men remaining more affected by their therapy than others. CONCLUSION: The findings do not support our first hypothesis that urinary, bowel and sexual problems in these men will return to baseline levels once therapy is completed and 2 years have elapsed. Our findings indicate the changes men experience are significant, do occur early, and many do not resolve in the longer term.

Survey on Visual Impairment and Refractive Errors on Ta'u Island, American Samoa.

PURPOSE: To assess the prevalence of presenting visual impairment and refractive errors on the isolated island of Ta'u, American Samoa. METHODS: Presenting visual acuity and refractive errors of 124 adults over 40 years of age (55 male and 69 female) were measured using the Snellen chart and an autorefractometer. This sample represented over 50% of the island's eligible population. RESULTS: In this survey, all presenting visual acuity (VA) was uncorrected. Of the included sample, 10.5% presented with visual impairment (visual acuity lower than 6/18, but equal to or better than 3/60 in the better eye) and 4.8% presented with VA worse than 6/60 in the better eye. Overall, 4.0% of subjects presented with hyperopia (+3 D or more), 3.2% were myopic (-1 D or less), and 0.8% presented with high myopia (-5 D or less). There was no significant difference between genders in terms of visual impairment or refractive errors. CONCLUSION: This study represents the first population-based survey on presenting visual acuity and refractive errors in American Samoa. In addition to providing baseline data on vision and refractive errors, we found that the prevalence of myopia and hyperopia was much lower than expected.

Case report: fracture of central intrauterine tube following insertion of high dose rate intracavitary applicator.

We present a unique complication of high dose rate afterloading intrauterine brachytherapy occurring in a patient requiring treatment for carcinoma of the uterus. A high dose rate afterloading intrauterine insertion was performed under general anaesthetic, following which routine check films revealed that the central uterine tube had fractured at the level of the cervical os.

Intrauterine high dose rate afterloading brachytherapy: experience of fractionated therapy using a cervical sleeve technique.

Using a standard three-channel Manchester-type tube and ovoid high dose rate applicator system, 46 consecutive patients have been treated for carcinoma of the cervix or endometrium. To facilitate fractionated treatments using high dose rate afterloading, a technique has been developed using an indwelling cervical sleeve inserted under an initial general anaesthetic. All patients received at least two insertions; in five patients we have delivered a total of six consecutive fractions on an outpatient basis without anaesthesia once the sleeve was in situ. Acute morbidity related to the procedure was some degree of uterine pain, which was relieved with nitrous oxide inhalation, and mild, but self-limiting, vaginal discharge. Complete late morbidity data are not yet available, but, in 30% of 25 evaluable patients, minor problems have been observed, particularly vaginal oedema and stenosis. Only one major late event has required surgery. Fractionated afterloading intrauterine brachytherapy can be delivered on an outpatient basis without anaesthesia using this cervical sleeve technique.