Survival After Stereotactic Body Radiation Therapy for Clinically Diagnosed or Biopsy-Proven Early-Stage NSCLC: A Systematic Review and Meta-Analysis.

INTRODUCTION: Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis, we assess survival outcomes after SBRT in studies with patients with clinically diagnosed versus biopsy-proven early-stage NSCLC. METHODS: The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival, and disease-free survival. The inverse variance method and the random effects method for meta-analysis were used to assess pooled survival estimates. RESULTS: A total of 11,195 nonduplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-year overall survival and lower 2-year and 5-year cancer-specific survival for biopsy-proven disease compared to clinical disease. However, 5-year overall survival was the same for both groups. For the pooled estimates, 3-year disease-free survival and 2-year cancer-specific survival were lower for biopsied disease. CONCLUSIONS: Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathologic conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathologic proof of malignancy.

Resection of a bony tumour of the chest wall with direct reconstruction using a sandwich technique: a standard technique for closure of large chest wall defects.

Bony tumours of the chest wall are rare and radical surgical resection forms the cornerstone of treatment. Closure of the defect following radical resection can be challenging. We report the case of a 59-year-old woman with a large tumour of the thoracic wall, which was surgically resected with direct reconstruction using a sandwich technique with a Palacos(®) patch placed in a double-layer Marlex mesh. Pathological examination showed a fibrous dysplasia of the rib. The patient had a good functional and cosmetic result.

Ancestry-shift refinement mapping of the C6orf97-ESR1 breast cancer susceptibility locus.

We used an approach that we term ancestry-shift refinement mapping to investigate an association, originally discovered in a GWAS of a Chinese population, between rs2046210[T] and breast cancer susceptibility. The locus is on 6q25.1 in proximity to the C6orf97 and estrogen receptor alpha (ESR1) genes. We identified a panel of SNPs that are correlated with rs2046210 in Chinese, but not necessarily so in other ancestral populations, and genotyped them in breast cancer case:control samples of Asian, European, and African origin, a total of 10,176 cases and 13,286 controls. We found that rs2046210[T] does not confer substantial risk of breast cancer in Europeans and Africans (OR = 1.04, P = 0.099, and OR = 0.98, P = 0.77, respectively). Rather, in those ancestries, an association signal arises from a group of less common SNPs typified by rs9397435. The rs9397435[G] allele was found to confer risk of breast cancer in European (OR = 1.15, P = 1.2 x 10(-3)), African (OR = 1.35, P = 0.014), and Asian (OR = 1.23, P = 2.9 x 10(-4)) population samples. Combined over all ancestries, the OR was 1.19 (P = 3.9 x 10(-7)), was without significant heterogeneity between ancestries (P(het) = 0.36) and the SNP fully accounted for the association signal in each ancestry. Haplotypes bearing rs9397435[G] are well tagged by rs2046210[T] only in Asians. The rs9397435[G] allele showed associations with both estrogen receptor positive and estrogen receptor negative breast cancer. Using early-draft data from the 1,000 Genomes project, we found that the risk allele of a novel SNP (rs77275268), which is closely correlated with rs9397435, disrupts a partially methylated CpG sequence within a known CTCF binding site. These studies demonstrate that shifting the analysis among ancestral populations can provide valuable resolution in association mapping.

Common variants on chromosome 5p12 confer susceptibility to estrogen receptor-positive breast cancer.

We carried out a genome-wide association study of breast cancer predisposition with replication and refinement studies involving 6,145 cases and 33,016 controls and identified two SNPs (rs4415084 and rs10941679) on 5p12 that confer risk, preferentially for estrogen receptor (ER)-positive tumors (OR = 1.27, P = 2.5 x 10(-12) for rs10941679). The nearest gene, MRPS30, was previously implicated in apoptosis, ER-positive tumors and favorable prognosis. A recently reported signal in FGFR2 was also found to associate specifically with ER-positive breast cancer.

Between the devil and the deep blue sea: an unusual kind of late cardiac tamponade with a therapeutic dilemma.

A 67-year-old patient underwent a left pneumectomy because of a moderately differentiated squamous cell carcinoma. Two weeks later, while still in hospital, he suddenly experienced an acute increase in dyspnoea. Pulmonary embolism was considered. However, echocardiography showed compression of the right ventricle and right atrium by an intrapericardial mass, confirmed by computed tomography. Following signs of a large thrombus in the inferior vena cava, pericardiocentesis was considered undesirable due to possible dislocation resulting from the sudden changes in intrapericardial pressure. Re-thoracotomy was equally undesirable because of the recent operation and status of the patient. After stabilisation and extensive consulting the patient was referred for pericardiocentesis by sternotomy. Huge blood clots were removed from the pericardial space. No thrombus mass was found in the inferior vena cava. The patient recovered uneventfully.

Capnocytophaga canimorsus sepsis presenting as an acute abdomen in an asplenic patient.

Acute abdominal symptoms are frequently caused by surgical intra-abdominal problems. However, the differential diagnosis also includes several internal diseases. Overwhelming infections may present with acute abdominal signs, particularly in the immunocompromised host. Asplenic patients are highly susceptible to infections with encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. Severe infections due to Capnocytophaga canimorsus (DF2), are also common in this group. C. canimorsus is a Gram-negative rod, present as a commensal organism in cat and dog saliva. We describe the atypical presentation of a fatal C. canimorsus-sepsis in a 46-year-old man, who underwent traumatic splenectomy two decades earlier.

Detection of breast cancer after biopsy for false-positive screening mammography. An increased risk?

INTRODUCTION: After false-positive screening for breast cancer, women are still at risk of developing breast cancer. In this study the incidence of breast cancer in a group of women who had a false-positive outcome is compared with the expected breast cancer incidence. METHODS: Follow-up data of 188 women (mean age 58 years) with a false-positive screening result were collected and analysed for breast cancer development. The mean length of follow-up in the study was 7.4 years. The occurrence of breast cancer was compared to the expected incidence of breast cancer in an age-matched control population using figures from the local cancer registration. RESULTS: The occurrence of breast cancer in the study population (n=7) was not significantly different from the expected incidence of breast cancer in the age-matched control group (n=5). CONCLUSION: There is no relationship between false-positive findings during breast cancer screening and later development of breast cancer. Patients who do not have an increased risk of developing breast cancer (due to family history) should not be followed-up clinically, but should be returned to the screening programme.

The use of X-ray for lymph node determination in the axillary dissection specimen.

A new and simple method by X-ray is described for lymph node determination in the axillary specimen of breast cancer patients. X-rays were performed of the axillary specimens of 49 women with breast cancer. The number of lymph nodes visible on the X-rays were assessed by two radiologists (A and B). The number of nodes identified in the axillary specimens was reported by the pathologist independently. The method described shows a clear correlation between the mean numbers of nodes counted on the X-rays of the specimens (radiologist A 18.3, B 16.1 nodes) and the mean numbers of nodes recovered by the pathologist (18.4). No intra-observer variation was observed and only a small inter-observer variation (2.2 nodes). This method of X-ray determination of lymph nodes can be used in auditing the surgeon's accuracy in performing complete axillary dissection as well as in auditing the number of lymph nodes found by the pathologist.

Cardiac tamponade: a rare but life-threatening complication of central venous catheters in children.

The widespread use of central venous catheters in the treatment of pediatric patients has caused an increased incidence of complications. A rare, but potentially fatal complication occurs when the heart is perforated by the catheter tip causing a cardiac tamponade. This perforation of the heart generally is associated with the insertion procedure, but may also occur after some time because of displacement of the catheter tip. The authors present three cases in which the placement of a central venous catheter resulted in lethal cardiac tamponade. Proper positioning of the catheter tip in the superior vena cava and a high index of suspicion are essential in preventing this serious complication. Contrast-enhanced chest x-ray after insertion of the catheter must be performed to ascertain a correct position of the tip.