Radiofrequency and microwave ablation for treatment of recurrent gynecologic malignancies.

OBJECTIVE: Radiofrequency ablation and microwave ablation are used to vaporize tumors not amenable to surgical resection. We sought to evaluate the safety and efficacy of radiofrequency and microwave ablation for the treatment of isolated lesions in patients with recurrent gynecologic malignancy. METHODS: Patients with gynecologic malignancies treated with radiofrequency or microwave ablation at a university-affiliated cancer center from April 2007 to January 2020 were evaluated. Clinical records were reviewed for number of prior chemotherapy regimens, response to ablation, time to progression, and location of progression. RESULTS: Thirty-two patients received ablative therapy for treatment of isolated recurrences. Seventeen (53%) patients had ovarian cancer, seven (22%) had endometrial cancer, and eight (25%) had cervical cancer. Thirteen (41%) patients received radiofrequency ablation and 19 (59%) received microwave ablation. Patients had a median of 2 (range 1-12) prior lines of chemotherapy. Sixteen (50%) patients achieved a partial or complete response with two patients experiencing no progression at time of submission. Six (19%) patients had stable disease and 10 (31%) patients had progression at time of initial follow-up imaging. Median progression-free survival for the cohort was 7.3 months (range 1.4-64.7). No significant improvement in median progression-free survival was seen with the addition of adjuvant systemic therapy to radiofrequency or microwave ablation (6.9 vs 7.7 months; HR 0.7, 95% CI 0.3 to 1.7). Clinical benefit, defined as absence of definitive progression at the site of ablation or new target lesions at 4 months, was seen in 22 (68.8%) patients. No major complications occurred, with two patients reporting pain or weakness at the site of ablation. CONCLUSION: Radiofrequency and microwave ablation demonstrated that 68.8% (n=22) of patients experienced clinical benefit at 4 months. Ablative therapy may be considered for the treatment of isolated lesions in patients with recurrent gynecologic malignancies.

A rare case of follicular dendritic sarcoma of the vagina.

Follicular dendritic sarcoma of the vagina is an exceptionally rare malignancy. Here, we present a reproductive-aged female with no pertinent past medical history who initially presented with a protruding vaginal mass. Pathology from initial excision was consistent with follicular dendritic sarcoma of the vagina. This was ultimately treated with wide radical resection of the mass leading to iatrogenic vaginal stenosis.

Taking CBL to the Lecture Hall: a Comparison of Outcomes Between Traditional Small Group CBL and a Novel Large Group Team-Based CBL Teaching Method.

PURPOSE: Case-based learning (CBL), an important component of medical school curricula, is an effective inquiry-based teaching method associated with high levels of student and teacher satisfaction. However, because traditional CBL requires small groups, its feasibility is limited by faculty and resources. We developed and tested a novel team-based CBL (TB-CBL) method to be implemented in the lecture hall. METHODS: All second-year students at our institution (n = 121) were randomized to either traditional small group CBL or TB-CBL during the Endocrine block and to the other modality during the Renal block. All students were exposed to both methods. Case content was identical, and sessions were run concurrently. This cross-over, non-inferiority study tested the hypothesis that no difference in knowledge acquisition, clinical reasoning, or student satisfaction would be detected between groups. RESULTS: Based on student performance on case-relevant exam questions, no difference in knowledge acquisition was seen between groups for either block (p = 0.62 Endocrine, p = 0.38 Renal). There was also no difference in overall final exam performance between groups (p = 0.56 Endocrine, p = 0.26 Renal). Case-relevant script concordance testing revealed no difference in clinical reasoning skills between groups (p = 0.87 Endocrine, p = 0.17 Renal). Satisfaction was higher for the TB-CBL format (p = 0.005). Cost analysis revealed that each small group CBL session costs $2654, while each TB-CBL session costs approximately $221. CONCLUSIONS: TB-CBL, a novel case-based teaching method, appears to produce similar learner outcomes and higher student satisfaction when compared with small group CBL. TB-CBL may be used to supplement case-based curricula while optimizing resource allocation.

Hidden burden of venous thromboembolism after trauma: A national analysis.

BACKGROUND: Trauma patients are at increased risk for venous thromboembolism (VTE). One in four trauma readmissions occur at a different hospital. There are no national studies measuring readmissions to different hospitals with VTE after trauma. Thus, the true national burden in trauma patients readmitted with VTE is unknown and can provide a benchmark to improve quality of care. METHODS: The Nationwide Readmission Database (2010-2014) was queried for patients ≥18 years non-electively admitted for trauma. Patients with VTE or inferior vena cava filter placement on index admission were excluded. Outcomes included 30-day and 1-year readmission to both index and different hospitals with a new diagnosis of VTE. Multivariable logistic regression identified risk factors. Results were weighted for national estimates. RESULTS: Of the 5,151,617 patients admitted for trauma, 1.2% (n = 61,800) were readmitted within 1 year with VTE. Of those, 29.6% (n = 18,296) were readmitted to a different hospital. Risk factors for readmission to a different hospital included index admission to a for-profit hospital (OR 1.33 [1.27-1.40], p < 0.001), skull fracture (OR 1.20 [1.08-1.35], p < 0.001), Medicaid (OR 1.16 [1.06-1.26], p < 0.001), hospitalization >7 days (OR 1.12 [1.07-1.18], p < 0.001), and the lowest quartile of median household income for patient ZIP code (OR 1.13 [1.07-1.19], p < 0.01). The yearly cost of 1-year readmission for VTE was $256.9 million, with $90.4 million (35.2%) as a result of different hospital readmission. CONCLUSIONS: Previously unreported, over one in three patients readmitted with VTE a year after hospitalization for trauma, accounting for over a third of the cost, present to another hospital and are not captured by current metrics. Risk factors are unique. This has significant implications for benchmarking, outcomes, prevention, and policy. LEVEL OF EVIDENCE: Epidemiological study, level II.