Changes in prostate apparent diffusion coefficient values during radiotherapy after neoadjuvant hormones.

BACKGROUND: Changes in prostate cancer apparent diffusion coefficient (ADC) derived from diffusion-weighted magnetic resonance imaging (MRI) provide a noninvasive method for assessing radiotherapy response. This may be attenuated by neoadjuvant hormone therapy (NA-HT). We investigate ADC values measured before, during and after external beam radiotherapy (EBRT) following NA-HT. METHODS: Patients with ⩾T2c biopsy-proven prostate cancer receiving 3 months of NA-HT plus definitive radiotherapy were prospectively identified. All underwent ADC-MRI scans in the week before EBRT, in the third week of EBRT and 8 weeks after its completion. Imaging was performed at 1.5 T. The tumour, peripheral zone (PZ) and central zone (CZ) of the prostate gland were identified and median ADC calculated for each region and time point. RESULTS: Between September and December 2014, 15 patients were enrolled (median age 68.3, range 57-78) with a median Gleason score of 7 (6-9) and prostate-specific antigen (PSA) at diagnosis 14 (3-197) ng/ml. Median period of NA-HT prior to first imaging was 96 days (69-115). All patients completed treatment. Median follow up was 25 months (7-34), with one patient relapsing in this time. Thirteen patients completed all imaging as intended, one withdrew after one scan and another missed the final imaging. PZ and CZ could not be identified in one patient. Median tumour ADC before, during and post radiotherapy was 1.24 × 10-3 mm2/s (interquartile range 0.16 × 10-3 mm2/s), 1.31 × 10-3 mm2/s (0.22 × 10-3 mm2/s), then 1.32 × 10-3 mm2/s (0.13 × 10-3 mm2/s) respectively (p > 0.05). There was no significant difference between median tumour and PZ or CZ ADC at any point. Gleason score did not correlate with ADC values. CONCLUSIONS: Differences in ADC parameters of normal and malignant tissue during EBRT appear attenuated by prior NA-HT. The use of changes in ADC as a predictive tool in this group may have limited utility.

The effect of electroacustimulation on postoperative nausea, vomiting, and pain in outpatient plastic surgery patients: a prospective, randomized, blinded, clinical trial.

BACKGROUND: Current rates of postoperative nausea and vomiting experienced by outpatient surgery patients are as high as 20 to 30 percent. Electroacustimulation therapy has been demonstrated to be effective in controlling these symptoms, but trials identifying its efficacy in the outpatient surgery population are lacking. METHODS: One hundred twenty-two patients undergoing surgical procedures at an outpatient surgery center were randomized to two treatment arms. The first arm received the standardized pharmacologic postoperative nausea and vomiting prevention typical for patients undergoing outpatient surgery, whereas in the second arm, the ReliefBand and pharmacologic measures were used. The ReliefBand is a U.S. Food and Drug Administration-approved electroacustimulation device. Electroacustimulation is a derivative of acupuncture therapy that uses a small electrical current to stimulate acupuncture points on the human body and is thought to relieve nausea, vomiting, and pain. Outcomes measured were pain and nausea symptoms, emetic events, the need for rescue medications, and the time to discharge. RESULTS: The electroacustimulation arm reported statistically significant lower nausea scores at 30 minutes and 120 minutes postoperatively (p < 0.05). In addition, subgroup analysis demonstrated significant findings in favor of the experimental group, with anatomical subsets of surgical patients requiring less pain medication and shorter times from surgery to discharge when compared with the standard treatment. However, electroacustimulation did not have a significant effect on the amount of pain experienced by patients in any group. CONCLUSION: The authors' study demonstrates that electroacustimulation offers added protection against symptoms of postoperative nausea and vomiting in an outpatient cosmetic surgery population, representing a safe and cost-effective addition to current pharmacologic preventive measures.