Common Treatment Modality Research Articles

Sinonasal Glomangiopericytoma: A Case Report and Literature Review

Glomangiopericytoma is a rare vascular tumor arising from the pericytes surrounding capillaries, and accounts for less than 0.5% of all sinonasal tumors. The aim of this study is to describe our recent experience of sinonasal glomangiopericytoma and thoroughly review our collected data on the basis of age/sex, location, associated diseases, clinical symptoms, endoscopic findings, image findings, pathology, and treatment. We found 21 articles (19 case reports and 2 review articles) relevant to our search since 2005. The mean age was 58.05 years, ranging from 19 years to 86 years with a female to male ratio of 3:1 (15:5). The most frequent site of origin was the nasal septum followed by the paranasal sinuses. The most common symptom was nasal obstruction, followed by epistaxis, headache, facial pain or pressure, and anosmia in decreasing order. Computed tomography was the most common imaging technique used to evaluate sinonasal glomangiopericytoma which the most common mentioned CT finding was soft tissue density mass with enhancement. The most common treatment modality was complete surgical excision through transnasal endoscopic surgery.
 Bangladesh Journal of Medical Science Vol.18(3) 2019 p.651-655

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma.

The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has evolved over the past few decades with the advancement of technology and improved imaging. Radiotherapy can offer high local control rates in unresectable HCC, including cases with major vascular involvement, and can provide a modality to help bridge patients to potentially curative resection or transplantation. In metastatic cases, radiotherapy can provide good palliation. This review focuses on the common radiotherapy treatment modalities used for HCC, provides outcome comparisons of these radiotherapy techniques to outcomes with other treatment modalities for HCC, and highlights the discrepancy of the role of radiotherapy in HCC amongst the current available treatment guidelines.

Risk factors of mortality in the patients with hepatocellular carcinoma: A multicenter study in Indonesia

Background and AimsHepatocellular carcinoma (HCC) is considered a significant burden, and its associated rate of mortality is increasing. Therefore, a population-based cancer registry is considered an essential element in the baseline and comprehensive analysis of the risk factors associated with HCC. We present a multicenter analysis of HCC registry from 2 hospitals in Indonesia. MethodsWe performed a follow-up on patients with HCC who were admitted between January 2015 and November 2017 in Cipto Mangunkusumo National General Hospital and Dharmais Hospital, Jakarta, Indonesia. Patient's death was considered the primary outcome of the study. A multivariate analysis was conducted using logistic regression, and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. ResultsA total of 282 patients with HCC included. At the last follow-up, 136 (48.2%) patients had died. Mortality rate was not significantly affected by sex, age, etiology, the presence of cirrhosis, nor surveillance of HCC. Based on the Child-Pugh (CP) classification, the OR increased progressively in CP C patients (OR 1.95; 95% CI 1.08-3.53; P = 0.026). The progressive increase was also found in patients with a higher Barcelona Clinic Liver Cancer stage, and the OR for CP C and D patients were 3.50 (95% CI 1.18-10.38; P = 0.024) and 3.41 (95% CI 1.02-11.41; P = 0.047), respectively. Supportive treatment was the most common treatment modality with an OR of 2.17 (95% CI 1.14-4.16; P = 0.019), and it was associated with the mortality rate of HCC. ConclusionsThe CP classification, Barcelona Clinic Liver Cancer staging system, and treatment modality might predict mortality in patients with HCC. Moreover, other parameters must be further evaluated.

Patterns of Treatment Modalities in Saudi Patients Treated with Dental Implants

Aim: The primary aim of this study was to detect the patterns of implant prosthetic treatment modalities among Saudi adults restored with dental implants in the Kingdom of Saudi Arabia. The secondary objective was to describe the status of the health insurance covering dental implants in Saudi Arabia.
 Materials and Methods: 323 Saudi patients aged ≥18 years residing in Saudi Arabia and treated with at least one dental implant were randomly selected and clinically examined for implant prostheses types (single-tooth, implant-supported long or short span conventional fixed bridge, implant overenture) done in dental premises (hospitals, polyclinics, private clinics, etc…) in Saudi Arabia. Radiographs were used too. The health insurance covering dental implants was detected. The data obtained including age, gender, systemic disease, and tobacco smoking were documented in a patient examination form then statistically analyzed using Chi-Square Test or Fisher-Freeman-Halton Test and U-Test.
 Results: The most frequently tooth type replaced by dental implants was the molars (46.9%), followed by premolars (41.6%), incisors (6.5%), and canines (5%); mandibular first molars were the most common tooth type replaced by implants. Single-tooth implant was the most common prosthetic treatment modality (88.3%), followed by implant-supported short span conventional fixed bridge (9.3%), implant overdenture (1.6%), and implant-supported long span conventional fixed bridge (0.9%). The percentages of single-tooth implant and implant-supported short span fixed bridge were higher in patients <40 years than in patients ≥40 years; however, in all age groups, single-tooth implant was the most common prosthesis type, and short span fixed bridge was the second most common prosthesis type. Of all teeth types replaced by dental implants, molars were the most common type in long span fixed bridges (36.1%) and in single-tooth implants (50.2%), and premolars were the most common type in short span fixed bridges (43.9%); also, of all teeth types replaced by dental implants, canines were the most common type in overdentures (56.7%). Incisors were mainly replaced by single-tooth implants (52.8%). There was an insignificant difference in the median of dental implants between males and females. 
 Conclusion: Single-tooth implant is major. Health insurance policy doesn’t cover dental implants in Saudi Arabia. Dental implant therapy is no more a complementary or an accessory procedure.

Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015.

Background:Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries.Purpose:To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials.Study Design:Cohort study; Level of evidence, 3.Methods:Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed.Results:In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01).Conclusion:From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

PMD20 CENTRIFUGAL VERSUS MEMBRANE THERAPEUTIC PLASMA EXCHANGE: SINGLE CENTER COST BENEFIT ANALYSIS IN THAILAND

Therapeutic plasma exchange (TPE) is a common treatment modality in management of various renal, hematological and neurological diseases in which large volume of plasma is removed and replaced with replacement fluid. Through TPE, pathologic substances that cause the underlying disease such as inflammatory mediators; autoantibodies, complement components and cytokines are eliminated and substantially improve patient quality of life. TPE can be performed using two categories of devices; membrane or centrifugal. We aimed to analyze the cost associated with these techniques from payer perspective. We estimated cost of membrane and centrifugal TPE based on 250 procedures performed annually in Prasat Neurological Institute, Thailand. Micro-costing approach was applied according to local clinical practice, and other probabilities were derived from published literature. Cost component includes device acquisition, maintenance, consumables, procedure time, plasma replacement fluids, clotting events and labor. The model assumed similar clinical outcome in these techniques. Overall estimated TPE cost per procedure using membrane and centrifugal techniques were USD 380 (rounded to nearest integer) and USD 241, respectively. We projected an annual savings of USD 34,759 (36%) for centrifugal TPE application in 250 procedures. The difference in the total time (set-up and procedure) for both techniques (mTPE, 150 minutes vs cTPE, 96 minutes) may be minimal for each procedure, however that translate to 6 weeks staff time saved per year for each centrifugal TPE procedure. We demonstrated that centrifugal TPE had a better cost benefit ratio than membrane TPE.

Comparison of the effect of three different topoisomerase II inhibitors combined with cisplatin in human glioblastoma cells sensitized with double strand break repair inhibitors

Topoisomerase II (Topo2) inhibitors in combination with cisplatin represent a common treatment modality used for glioma patients. The main mechanism of their action involves induction of DNA double-strand breaks (DSBs). DSBs are repaired via the homology-dependent DNA repair (HRR) and non-homologous end-joining (NHEJ). Inhibition of the NHEJ or HRR pathway sensitizes cancer cells to the treatment. In this work, we investigated the effect of three Topo2 inhibitors—etoposide, NK314, or HU-331 in combination with cisplatin in the U-87 human glioblastoma cell line. Etoposide as well as NK314 inhibited Topo2 activity by stabilizing Topo2-DNA cleavable complexes whereas HU-331 inhibited the ATPase activity of Topo2 using a noncompetitive mechanism. To increase the effectiveness of the treatment, we combined cisplatin and Topo2 inhibitor treatment with DSB repair inhibitors (DRIs). The cells were sensitized with NHEJ inhibitor, NU7441, or the novel HRR inhibitor, YU238259, prior to drug treatment. All of the investigated Topo2 inhibitors in combination with cisplatin efficiently killed the U-87 cells. The most cytotoxic effect was observed for the cisplatin + HU331 treatment scheme and this effect was significantly increased when a DRI pretreatment was used; however, we did not observed DSBs. Therefore, the molecular mechanism of cytotoxicity caused by the cisplatin + HU331 treatment scheme is yet to be evaluated. We observed a concentration-dependent change in DSB levels and accumulation at the G2/M checkpoint and S-phase in glioma cells incubated with NK314/cisplatin and etoposide/cisplatin. In conclusion, in combination with cisplatin, HU331 is the most potent Topo2 inhibitor of human glioblastoma cells.

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single-centre retrospective audit of 236 cases.

The role of selected treatments for brain metastases (BM) is well documented; however, the prevalence of these is not. We report on the patterns of care in the management of BM in a large oncology centre. We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases-related admissions. Eighty-two per cent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole-brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. This is the first study in the UK that gives an in-depth overview of the real-world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however, care needs to be taken in ensuring that SRS is offered to those who are suitable.

Effects and Complications of Intravesical Instillation of Bacillus Calmette-Guerin Therapy

This review will address the current literature available regarding complications after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Topics include intravesical BCG therapy–related complications, role of BCG therapy in immunosuppression, and future directions in the context of BCG-related complications. There are several new reviews and case reports discussing unique complications following intravesical BCG therapy that should raise awareness of possible short-term and long-term effects after using this common treatment modality in bladder cancer patients. Since intravesical BCG is a common treatment option for non-muscle invasive bladder cancer and can cause a variety of complications, it is important to recognize this aspect of the patient’s history when evaluating patients who present with symptoms similar to the ones discussed in this review. This will allow for prompt delivery of treatment as well as preventing unnecessary morbidity and mortality.

Medication-related issues associated with the documentation and administration of long-acting injectable antipsychotics.

Background There are significant research gaps into understanding the extent of medication errors within mental health and variation in the uptake of standardised medication safety practices. Long-acting injectable antipsychotic (LAIA) preparations are a common treatment modality for the administration of antipsychotic medicines. Aim of the review To examine the literature on medication-related errors and practice issues associated with the documentation and administration of LAIAs. Method Electronic databases were searched for articles exploring medication errors in mental health, charting and administration of LAIAs, standardised medication charts, documentation of LAIAs and strategies or interventions to improve medication safety with LAIAs. Results Nineteen articles met the inclusion criteria. Medication errors in mental health were mostly related to the clerical or procedural aspects of prescribing. Standardised charts have been shown to reduce prescribing and administration errors. Divergent practices across mental health services were reported and this lack of standardisation in ordering and administering LAIAs contributes to errors. Discrepancies between guidelines and current practice with the administration of LAIAs were also identified. Evidence demonstrates that clinical pharmacy services reduces medication errors, and increased pharmacist involvement in LAIA care coordination improves communication and documentation with LAIAs. Further investigation focusing on standardisation of charting, administration and documentation of LAIAs is required. Conclusion Limited studies were identified that assess the charting, administration and documentation of LAIAs. Future research is required to review current local practices with LAIAs and identify substandard areas so that specific clinical interventions can be implemented and evaluated.

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real-life data from the Scandinavian registry (HISREG).

Hidradenitis suppurativa (HS) substantially affects health-related quality-of-life outcomes. Most treatment options are supported by low quality of evidence without validated outcomes. The aim of this study was to evaluate the efficacy of surgical and medical interventions using physician- and patient-reported outcomes registered in HISREG. Data were extracted for all adult patients registered in HISREG between January 2013 and April 2016. Primary endpoints included Dermatology Life Quality Index (DLQI) scores, pain as measured using a numeric rating scale (NRS), Sartorius score and Hurley classification. Minimum clinically important differences (MCIDs) for DLQI and NRS pain were analysed. Secondary endpoints included comparisons among different treatment groups, safety and complications of various treatments. Two hundred and fifty-five patients were included in the study: 31, 188, and 36 patients had Hurley stages I, II and III disease, respectively. Treatment with CO2 lasers was the most common treatment modality. One hundred and forty-nine patients (58.4%) were treated with surgical intervention, 87 (34.1%) received antibiotics and/or anti-inflammatory treatments, and 19 (7.5%) were treated with both surgery and medical intervention. No patients received biologic treatment. In patients with surgical treatments, Sartorius scores were significantly improved compared with baseline (P=0.001), 83 patients (55%) achieved a DLQI MCID, and 75 patients (49.7%) achieved an NRS pain MCID. In patients with medical treatments, Sartorius scores were not significantly improved compared with baseline (P=0.582); 25 patients (28%) achieved a DLQI MCID and 28 patients (31%) achieved an NRS pain MCID. In patients treated with surgical and medical combination, 9 (48%) achieved DLQI and NRS pain MCIDs and Sartorius scores were significantly improved. CO2 laser treatment is more effective than the non-biologic medical treatments in this analysis based on physician- and patient-derived outcomes. The study provides limited evidence for the combination of medical and surgical therapies in patients with HS.

Efficacy of laser acupuncture for patients with chronic Bell's palsy: A study protocol for a randomized, double-blind, sham-controlled pilot trial.

Background:Bell's palsy is the most frequent cause of unilateral peripheral facial palsy, a common condition that third of patients can have inadequate recovery and subsequent physical and social impairments. The largely ineffective and even controversial nature of the various medical and surgical treatment options means that novel, alternative approaches are needed. In preclinical and clinical evidence, low-level laser therapy (LLLT) has demonstrated the ability to regenerate peripheral nerves. Laser acupuncture treatment (LAT), the stimulation of traditional acupoints with low-intensity, non-thermal laser irradiation, is a common treatment modality, but its efficacy in chronic Bell's palsy is undetermined. This study aims to evaluate the efficacy of LAT in patients experiencing inadequate recovery from Bell's palsy.Methods:This 2-armed, parallel, randomized, subject-assessor-blinded, single-center, sham-controlled pilot trial will randomly assign 32 eligible patients into either a real LAT group (n = 16) or a sham LAT group (n = 16). The real LAT group will receive 3 LAT sessions each week for 6 weeks (a total of 18 sessions), delivered to acupoints corresponding with the affected side of the face. The sham LAT group will receive the same treatment as the real LAT group, but with a sham laser device. The primary outcome measure will be the change from baseline at week 6 in the Facial Disability Index score. Secondary outcomes will monitor changes during treatment in the House-Brackmann and Sunnybrook facial nerve grading systems and stiffness scale, at weeks 1, 3, and 6.Discussion:To the best of our knowledge, this double-blind, randomized, sham-controlled trial is the first such investigation into the efficacy of LAT in chronic Bell's palsy. Clinical trials using LLLT have shown positive therapeutic effects in acute Bell's palsy, although as yet, the feasibility and efficacy of LAT remain unclear in patients experiencing inadequate recovery from Bell's palsy.Trial registration:This trial protocol has been approved by the Research Ethics Committee of the China Medical University Hospital, Taichung, Taiwan (Protocol ID: CMUH107-REC1-030) also registered at ClinicalTrials.gov (identifier no. NCT03592797).

Bilateral advanced (group D or E) intraocular retinoblastoma: outcomes in 72 Asian Indian patients.

To study the clinical presentation, treatment, and outcomes of patients with bilateral advanced intraocular retinoblastoma. Retrospective case series of 72 patients. The mean age at presentation was 19 months. Leukocoria (n = 49, 68%) was the most common presenting complaint. The tumors were classified as groups D (n = 60, 42%) or E (n = 84, 58%) based on the Philadelphia version of International Classification of Retinoblastoma (ICRB); groups D (n = 84, 58%) or E (n = 60, 42%) based on Children's Hospital Los Angeles version of International Classification of Intraocular Retinoblastoma (ICIoR); T2 (n = 116, 81%) or T3 (n = 28, 19%) based on 8th edition American Joint Committee Classification (AJCC). Systemic chemotherapy (n = 138, 96%) was the most common primary treatment modality. The chance of globe salvage was higher for group D based on ICRB (83%; odds ratio (OR) 7.73; 95% confidence interval (CI) 3.45-17.33) or ICIoR (81%; OR 12.75; 95% CI 5.74-28.34) and T2b (73%; OR 5.19; 95% CI 2.51-10.73) based on AJCC. Over a mean follow-up period of 59 months, tumor recurrence was noted in 42 (29%) eyes and globe salvage was achieved in 83 (58%) eyes. Of the 50 eyes where vision was recorded, vision of 20/200 or better was achieved in 24 (48%) eyes. There were events of leukemia (n = 1, 1%), pinealoblastoma (n = 1, 1%), systemic metastasis (n = 3, 4%), and death (n = 4, 6%) during the follow-up period. Multimodality treatment allows globe salvage (58%) and vision salvage (48%) in eyes with advanced group D and E intraocular retinoblastoma.

Long-term Benefit of Unilateral Cochlear Implantation on Quality of Life and Speech Perception in Bilaterally Deafened Patients.

Cochlear implantation (CI) is a common treatment modality for unilaterally and bilaterally deafened patients as well as patients with severe to profound hearing loss. The aim of our study is the complex evaluation of the improvement and influence of health related quality of life (HRQoL) and auditory performance in cochlear implant patients during a long-term follow-up. Sixty-one bilaterally, postlingually deafened patients with unilateral CI were included in this prospective study. Assessment tools for auditory performance and HRQoL included the Freiburg Monosyllabic Speech test, Oldenburg Inventory (OI) questionnaire, Nijmegen Cochlear Implant Questionnaire (NCIQ) and 36-item Short Form Survey (SF-36). Data were collected before CI, at 6, 12, and 24 months postoperatively. The assessment tools for speech perception yielded a statistically significant improvement in the Freiburg Monosyllabic Speech test scores and of all subdomain scores of the OI during the 6-month follow-up period. The subdomain scores of the NCIQ and the psychological score of the SF-36 also improved significantly during this follow-up period. All results remained stable thereafter during the 12- and 24-month follow-up. There was a statistically significant correlation between subjective speech perception and HRQoL after CI. This is the first prospective study to show results in regard to speech perception and HRQoL and their correlation during a 2-year follow-up after unilateral CI in bilaterally deafened patients. Our results for speech perception and HRQoL showed a significant improvement during the 6-month follow-up that remained stable thereafter during a 24-month follow-up, even after finishing the hearing rehabilitation program.

Thrombopoietin Receptor Agonists: Can These Be the Future Answer to the Deadly Thrombocytopenia in Dengue Fever?

Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.

Highlights of This Issue

The antidiabetic drug metformin has been shown to have anti-cancer properties that are poorly understood. Here, Hart and colleagues demonstrate that metformin inhibits the nuclear translocation and transcriptional activity of hypoxia-inducible factor (HIF)-1α and -2α. This in turn blocked the expression of sphingosine kinase 1 (SPHK1) and its target, sphingosine-1-phosphate (S1P), which are upregulated in ovarian cancer patients and are predictive of tumor aggressiveness and poor outcome. The authors suggest that patients with high SPHK1-S1P pathway activity may demonstrate considerable benefit from treatment with metformin.The epithelial-to-mesenchymal transition (EMT) is a critical step in the pathology and progression of cancer. In this study, Short and colleagues identify serine threonine kinase 17A (STK17A) as a key regulator of EMT in colorectal cancer. Loss of STK17A was associated with acquisition of a mesenchymal phenotype and increased invasive spread, whereas reactivation of STK17A signaling caused reversion to an epithelial phenotype and increased sensitivity to apoptotic signaling. Taken together, their data indicate a novel role for STK17A in controlling metastatic spread in colorectal cancer.Cisplatin therapy is a key component of the standard of care for pediatric osteosarcoma, but its potential to increase mutational burden in the tumor has yet to be defined. Here, Brady and colleagues demonstrate a unique mutational signature in metastatic samples from patients treated with cisplatin. The cisplatin signature accounted for greater than 40% of mutations in metastatic lesions and was associated with acquisition of putative driver mutations upon seeding of distant metastases. These data indicate widespread clonal heterogeneity in metastatic osteosarcoma, which could inform the optimal treatment of patients with recurrent disease.Ionizing radiation (IR) is a common treatment modality for many localized cancers, but its widespread genotoxic effects have the potential to induce tumorigenic mutations as well. Repullés and colleagues demonstrate that IR delivered to primary breast cells resulted in increased colony size and disrupted cellular polarity. Additionally, immortalized pre-malignant cells bearing hTERT and SV40 small and large T antigens displayed heightened sensitivity to radiation-induced cell transformation. Though cells from different donors displayed differential sensitivity to IR, these data imply that patients bearing premalignant genetic lesions may be at increased risk of developing oncogenic driver mutations in response to radiotherapy.

264 Male Sexual Dysfunction after Prostate Radiotherapy: A Review and Guide to Management

Prostate cancer is the second leading cause of cancer related death in men. Radiation is a common treatment option and modalities include external beam radiation and brachytherapy. As a result of this treatment, male sexual dysfunction commonly occurs afterwards. The pathophysiology is multifactorial and is related to arterial and nerve damage. Loss of erectile function had been attributed to physiologic stress and a worsened quality of life. In addition, ischemia and scarring to the ejaculatory ducts commonly leads to anejaculation which has been shown to further exacerbate symptoms and impact libido and satisfaction. Management of patient’s erectile function after radiation requires a complicated, multi-modal approach including perspectives from radiation oncology, urology, and psychiatry. Provide a framework for practitioners regarding sexual dysfunction in men post radiotherapy for prostate cancer from a clinical, epidemiologic, and psychosocial aspect. Multi-institutional collaborative literature review from urology, radiation oncology, and psychiatry. We specifically targeted erectile dysfunction, libido, altered ejaculation, and orgasm. Particular focus was placed on psychological impact of these issues and optimal management in this patient population.

Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence

Transoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10. Primary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments. Voice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression. Age and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.

Dermatologic Toxicities: A Chart Review of Clinical Management Among Patients With Metastatic Colorectal Cancer Treated With Panitumumab.

At least 90% of patients with metastatic colorectal cancer (mCRC) who are treated with an anti-EGFR will develop a dermatologic toxicity. Preemptive management strategies have been shown to reduce the severity of rash. This article aims to describe treatment modalities used for the management of dermatologic toxicity among patients with mCRC who were treated with panitumumab and to assess the proportion of patients who were recommended preemptive versus reactive management strategies. This retrospective chart review evaluated different treatment modalities and routes of administration. The modalities were categorized as prescription or over-the-counter. The timing in relation to the first dose of panitumumab was used to define preemptive versus reactive treatments. In a sample of 330 patients, only 10% of patients were recommended to begin treatment for rash preemptively. The two most common treatment modalities for preemptively and reactively treated patients were prescription oral antibiotics and prescription topical antibiotics.

Swallowing Skills and Aspiration Risk Following Treatment of Head and Neck Cancers.

Surgical resection and chemoradiation are common modalities of treatment in head and neck cancers. Dysphagia is one of the common complications following these interventions. The severity of dysphagia depends on various factors, site and extent of resection, and radiation therapy to highlight a few. Thirty-five head and neck cancer patients treated with surgical and/or chemoradiation were assessed for parameters of swallowing. Extent of resection was statistically associated with swallowing symptoms phase wise. The results revealed a strong association between the presence of aspiration with resection of the tongue base and radiation therapy (p < 0.01). Oral preparatory and oral phase abnormalities were present in all the cases with varying severity especially in cases where the mandible and body of tongue were compromised (p < 0.05). These findings provide a specific profile which has high clinical utility.