RESUMO
PURPOSE: To explain the concepts that radiation oncologists need to understand to manage patients with juvenile nasopharyngeal angiofibroma (JNA). To accomplish this goal we first describe our institution's experience with radiotherapy for JNA and then use this data set as a framework for explaining the role of radiotherapy in the treatment of this uncommon tumor. METHODS AND MATERIALS: We studied the outcomes of all 24 patients treated with radiotherapy for JNA at our institution. All patients had at least 4 years of follow-up (median follow-up, 18 years). The standard dose in the first half of the series was 30 Gy in 22 treatments (1.43 Gy/treatment). After observing recurrences with this schedule, the prescription was changed to 35 to 36 Gy at 1.8 Gy/treatment. In all cases, the target volume was the primary site without an attempt to cover the regional nodes. RESULTS: All recurrences were at the primary site and presented within 5 years of completing radiotherapy. There appeared to be a dose response for tumor control: 77% with 30 to 32 Gy versus 91% with 35 to 36 Gy. All recurrences following radiotherapy were successfully salvaged with surgery. The only complications from radiotherapy were cataracts in 2 patients. No patient had a significant growth abnormality or second tumor. CONCLUSIONS: Surgery is the best treatment for JNA when cure is likely with low morbidity, but the threshold for using radiotherapy should be low because moderate-dose radiotherapy cures about 90% of patients with a low risk of serious complications. We recommend 36 Gy at 1.8 Gy per treatment in most cases. Elective nodal irradiation is not necessary. Radiographic response should be almost complete within a year of radiotherapy. Patients should be followed with cross-sectional imaging every 6 months for at least 5 years.
RESUMO
BACKGROUND: Long-term hemodialysis is associated with impaired quality of life (QOL) and depression, which are thought to worsen compliance with the treatment regimen. With the success of our hospital's Arts-in-Medicine Program, we launched a similar set of activities in the long-term dialysis unit and sought to measure their effects. METHODS: At baseline and 6 months, we administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Beck depression scales to 46 patients (44% men; mean age, 52 years) and assessed their percentage of achieved dialysis time, interdialytic weight gain, and predialysis laboratory results. We tested for a relationship between these variables and Arts-in-Medicine Program participation (low and high; 51% and 49%). Arts in Medicine was offered each shift, led by artists, and included artwork, crocheting, crafts, seasonal displays, poetry, and playing musical instruments. RESULTS: At 6 months, the patients, nurses, technicians, and physicians subjectively believed that Arts in Medicine had a positive impact on the unit. In paired comparisons to baseline, there was significant improvement in SF-36 scores for Role-Physical (mean values, 34.4 to 38.7; P = 0.04), less weight gain (3.6 to 3.2 kg; P = 0.02), greater serum carbon dioxide content (20.4 to 22.5 mEq/L [mmol/L]; P < 0.01), greater phosphate levels (5.3 to 5.7 mg/dL [1.71 to 1.84 mmol/L]; P = 0.04), and a trend to less depression (Beck score, 15.3 to 12.1; P = 0.07). Regression analyses showed that high participation correlated with improved SF-36 scores for Social Function (11.1-unit increase; P = 0.01), Bodily Pain (7.6-unit increase; P = 0.04), and Role-Physical (6.6-unit increase; P = 0.06), as well as a trend to greater albumin levels (0.11 g/dL [1.1 g/L]; P = 0.08), but with greater phosphate (0.8 mg/dL [0.26 mmol/L]; P = 0.01) and lower calcium levels (0.3 mg/dL [0.07 mmol/L]; P = 0.07). CONCLUSION: Participation in a new Arts-in-Medicine Program correlated with improved QOL measures, and there were encouraging trends for depression, as well as certain laboratory and hemodialysis parameters.
