The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers.

PURPOSE: Intensity-modulated radiotherapy is developed as a replacement for 3-dimensional conformal radiation therapy. Considering the difference in costs and effectiveness of these interventions, the aim of this study was to compare the cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancer in east of Iran. METHODS: A Markov model including six states based on xerostomia and dysphagia was developed to estimate the incremental cost effectiveness ratio from the perspective of societal. Cost and quality of life data were collected from 97 respondents via a checklist and EuroQol-5Dimension questionnaire. The robustness of results was examined by deterministic and probabilistic sensitivity analysis. All analysis were conducted with Treeage software. RESULTS: The results of this study showed that the cost and quality adjusted life years for 3-dimensional conformal radiation therapy were 9209.76 and 3.63 respectively. However, the cost and quality adjusted life years for intensity-modulated radiotherapy were 12562.90 and 3.17 respectively. Therefore, 3-dimensional conformal radiation therapy produced 0.45 more quality adjusted life years than intensity-modulated radiotherapy and saved $3353. According to the incremental cost effectiveness ratio, 3-dimensional conformal radiation therapy as compared to intensity-modulated radiotherapy saved $7367.27 per quality adjusted life years. These results confirmed by sensitivity analysis. CONCLUSION: This study concluded that in the treatment of head and neck cancer, the 3-dimensional conformal radiation therapy method appears to be cost-effective when compared with intensity-modulated radiotherapy.

Subcutaneous octreotide therapy for malignant pleural effusion after pleurodesis with talc powder: a placebo-controlled, triple-blind, randomized trial.

PURPOSE: In many cases, pleurodesis is the only treatment available for the treatment of malignant pleural effusion (MPE), and in the case of excessive daily pleural effusion, its therapeutic effect may be reduced. In this study, we intended to investigate the therapeutic effects and safety of octreotide in patients with MPE undergoing pleurodesis with talc powder. METHODS: This study was a single-center, placebo-controlled, and triple-blind, randomized trial designed to investigate the therapeutic effects and safety of octreotide in patients with MPE in Tehran, Iran, from March 2020 to March 2021. Patients with MPE were randomly divided into two parallel groups, one receiving subcutaneous octreotide (3 doses of 50 µg/day) and the other receiving placebo before and after pleurodesis with talc powder. The patients were followed up with a chest X-ray 1 week, 1 month, and 3 months later. The primary outcome measures of this study were the amount of discharge from the chest tube before and after pleurodesis and the length of hospital stay. Treatment failure, relapse, pleural effusion analysis, and side effects were considered the secondary outcome measures of the study. RESULTS: A total of 46 patients (23 in the octreotide group and 23 in the placebo group) with MPE was included in this study. Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder. We showed that compared to the placebo group, patients in the octreotide group have significantly decreased production of pleural effusion both before (p = 0.009) and after (p = 0.002) pleurodesis. Octreotide treatment led to a decreased hospital stay (p = 0.004 before pleurodesis and p = 0.001 after pleurodesis) and reduced treatment failure (p = 0.022). However, octreotide did not decrease the relapse at 1-week, 1-month, and 3-month follow-ups. Moreover, octreotide did not affect pleural effusion parameters compared to placebo. Ultimately, our results also showed that treatment with octreotide was safe and did not have significant side effects. CONCLUSION: Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder without any significant side effects. Future studies with a larger sample size and longer follow-up time can confirm the results of this study and also determine the appropriate dose of octreotide for the treatment of MPE. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20210915052492N1. Registered 11 October 2021 - Retrospectively registered, https://www.irct.ir/trial/58776 .

A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum.

INTRODUCTION: Laparoscopic cholecystectomy (LC) has become the gold-standard treatment for gallstone diseases. However, despite huge reduction in operative injury, systemic stress response remains high. This randomized controlled trial (RCT) aimed to compare systemic stress response between 2 different techniques of CO2 pneumoperitoneum. METHODS: Trough a prospective, double-blinded RCT, serum levels of cortisol, adrenaline, glucose, and C-reactive protein (CRP) were compared between the two groups consisted of 50 patients undergoing LC under low-pressure and standard-pressure CO2 pneimoperitoneum. RESULTS: A total of fifty patients undergoing LC were equally assigned to 2 groups of twenty five patients. Average age was 48 ± 13.8 years (range, 19-74 years). Operative time was similar between standard-pressure group (47.8 ± 16.8 min) and low-pressure group (53.6 ± 25.1). Moreover, intra-operative IV volume administration and urine output did not differ significantly between the 2 groups (p > 0.05). Although the average heart rate and mean arterial pressure were slightly higher in a standard-pressure group compared with a low-pressure group, serial measurements of these parameters were statistically similar between the 2 groups. Serial changes of serum levels of cortisol, glucose, adrenaline, and CRP were compared between surgery day, postoperative 6-h and 1st postoperative day, which did not differ significantly between the standard-pressure and the low-pressure groups (p > 0.05). CONCLUSION: Our study did not reveal any alteration in systemic stress response with reduction in intra-abdominal pressure of pneumoperitoneum in LC. RCT REGISTRATION: irct.ir ID: IRCT201110072982N5.