RESUMEN
AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Radiocirugia/mortalidad , Anciano , Anciano de 80 o más Años , Instituciones Oncológicas , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Tomografía Computarizada Cuatridimensional , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radiocirugia/métodos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To determine whether women with a history of surgery for cervical intraepithelial neoplasia (CIN) are at an increased risk of subfertility, measured as a time to pregnancy of more than 12 months. DESIGN: Case-control study. SETTING: Iowa Health in Pregnancy Study (IHIPS), a population-based case-control study of preterm and small-for-gestational-age (SGA) live birth outcomes (from May 2002 through June 2005) in the USA. SAMPLE: Women with an intended pregnancy and a history of either one prior cervical surgery (n = 152), colposcopy only (n = 151), or no prior cervical surgery or colposcopy (n = 1021). METHODS: Cervical treatment history, pregnancy intention, time to pregnancy, and other variables were self-reported by computer-assisted telephone interviews. Odds ratios were calculated using logistic regression to estimate the risk of prolonged time to pregnancy among women with a history of cervical surgery or colposcopy alone, compared with untreated women (control group). MAIN OUTCOME MEASURE: Prolonged time to pregnancy (i.e. >1 year). RESULTS: Prolonged time to pregnancy was most prevalent among treated women (16.4%), compared with untreated women (8.4%) and women with colposcopy only (8.6%) (P = 0.039). After adjusting for covariates, women with prior cervical surgery had a more than two-fold higher risk of prolonged time to pregnancy compared with untreated women (aOR 2.09, 95% CI 1.26-3.46). In contrast, women with a history of colposcopy only had a risk equivalent to that found among untreated women (aOR 1.02, 95% CI 0.56-1.89). CONCLUSIONS: Women with a history of cervical treatment for CIN are at increased risk of subfertility, measured as a time to pregnancy of more than 12 months.
Asunto(s)
Infertilidad Femenina/etiología , Complicaciones Neoplásicas del Embarazo/cirugía , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Fertilización , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional , Infertilidad Femenina/epidemiología , Infertilidad Femenina/cirugía , Iowa , Nacimiento Vivo , Persona de Mediana Edad , Embarazo , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. PATIENTS: Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. INTERVENTIONS: Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. OUTCOME MEASURES: For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. RESULTS: There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. CONCLUSIONS: Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.
Asunto(s)
Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Paladar Duro/cirugía , Niño , Preescolar , Fisura del Paladar/complicaciones , Femenino , Humanos , Lactante , Masculino , Maxilar/crecimiento & desarrollo , Nariz/patología , Fístula Oral/etiología , Fístula Oral/cirugía , Procedimientos de Cirugía Plástica/métodos , Pruebas de Articulación del Habla , Colgajos Quirúrgicos , Resultado del Tratamiento , Insuficiencia Velofaríngea/etiología , Calidad de la VozRESUMEN
The speech development of nine children with cleft lip/palate was followed longitudinally from nine months to three years of age. The results indicate speech sound development closer to the non-cleft population than previous studies. Nasal fricatives previously not extensively described in the literature may be an experimental stage of developmental babble, which spontaneously reduce. The study has added to the evidence-base for practice in one cleft unit. It may be useful to channel resources at our centre to children who at nine months may be more at risk, i.e. children with bilateral clefts and known developmental delay.
Asunto(s)
Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Trastornos del Habla/diagnóstico , Habla , Preescolar , Labio Leporino/complicaciones , Labio Leporino/psicología , Fisura del Paladar/complicaciones , Fisura del Paladar/psicología , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Fonética , Trastornos del Habla/etiologíaRESUMEN
In this review, normal speech and its development is described and compared with the patterns typical of cleft palate speech. Attention is drawn to the importance of measuring and analysing these factors adequately for research and audit purposes, and the need for agreed parameters for reporting outcomes.
Asunto(s)
Fisura del Paladar/fisiopatología , Habla/fisiología , Niño , Preescolar , Fisura del Paladar/complicaciones , Humanos , Lactante , Recién Nacido , Trastornos del Habla/etiología , Inteligibilidad del Habla/fisiología , Medición de la Producción del Habla , Insuficiencia Velofaríngea/fisiopatologíaAsunto(s)
Endoscopía/métodos , Cooperación del Paciente , Juego e Implementos de Juego , Niño , HumanosRESUMEN
The results of clinical and radiographic assessment of palate re-repair (by a single operator) in 32 patients are presented. This has shown that radical muscle correction as a secondary procedure (following limited or no muscle correction in primary repair) has produced measurable improvement in velar function and should be considered as the first option in many patients with velopharyngeal incompetence. The results also support the concept of muscle dissection and retropositioning in primary cleft palate repair.
Asunto(s)
Fisura del Paladar/cirugía , Músculos/cirugía , Insuficiencia Velofaríngea/cirugía , Adolescente , Adulto , Niño , Preescolar , Endoscopía , Femenino , Fluoroscopía , Humanos , Masculino , Paladar Blando/diagnóstico por imagen , Paladar Blando/fisiopatología , Periodo Posoperatorio , Pronóstico , Reoperación/métodos , Habla/fisiología , Insuficiencia Velofaríngea/diagnóstico por imagenRESUMEN
To overcome the difficulty of obtaining adequate videofluoroscopic images with small children because of lack of cooperation and their inability to keep their heads still and correctly rotated, a 3D View-Master was attached to the x-ray table. Its use greatly increased the ability to conduct lateral videofluoroscopies of small children by improving patient compliance, stabilizing rotation and reducing unwanted head movement, and by standardizing magnification.