Follow-up Of Cancer Patients Research Articles

Plasma soluble human leukocyte antigen G predicts the long-term prognosis in patients with colorectal cancer.

BackgroundColorectal cancer (CRC) is the third most common tumor in the world. It is crucial to further screen for indicators that are strictly related to long-term prognosis. Human leukocyte antigen G (HLA-G) is closely involved in tumor development. This study aims to evaluate the long-term predictive value of soluble HLA-G (sHLA-G) in CRC through a double-center retrospective study.MethodsPatients who underwent radical CRC surgery in two hospitals from April 2010 to March 2015 were included. Baseline data of the patients were collected. The patients’ preoperative baseline plasma sHLA-G level was detected. According to whether they survived during five years of follow-up, these patients were divided into two groups. Univariate and multivariate analysis were used to find factors associated with survival. The receiver operation curve (ROC) was performed to analyze the relationship between sHLA-G level and five-year survival, and the cutoff value was obtained. The baseline data and follow-up results of the two groups of patients were compared, and the Kaplan-Meier survival curve was used to analyze the difference in the long-term prognosis of the two groups of patients.ResultsA total of 1,037 cases were included and followed up for more than five years. Three hundred two cases (29.1%) died during the five-year follow-up. The baseline data of the survival group and the death group showed that the baseline level of sHLA-G in the survival group was significantly lower than the death group (41.4±16.9 vs. 64.7±23.2, P<0.05). Univariate and multivariate analyses suggest that age, differentiation, family history, TNM stage, and baseline sHLA-G levels are important factors affecting the survival of CRC patients. The area under ROC of sHLA-G with five-year survival is 0.766, and the cutoff value is 50.8 U/mL. The specificity at this point is 78.1%, and the sensitivity is 72.3%. The Kaplan-Meier survival curve showed that the five-year prognosis of patients in the low-level group was better than that in the high-level group.ConclusionsLower baseline sHLA-G level predicts better prognosis during a five-year follow-up in colorectal cancer patients.

Application value of 18F-FDG PETCT imaging in the clinical initial diagnosis and follow-up of primary lesions of cervical cancer.

BackgroundCervical cancer is a common malignant tumor in gynecology with a high death rate. his study aims to analyze the application value of 18F-fluorodeoxyglucose imaging examination (18F-FDG PETCT) imaging in the initial clinical diagnosis and follow-up examination of cervical cancer.MethodsThe clinical data of 71 patients with cervical lesions who were admitted to our hospital from March 2017 to March 2019 were retrospectively collected all patients underwent 18F-FDG PETCT examination. The results of the pathological examination were a benchmark to calculate the sensitivity, specificity, and accuracy of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer and the diagnosis of postoperative recurrence, residual, and metastasis.ResultsThere were 39 patients initially suspected, and 30 cases were diagnosed as cervical cancer by pathological examination, including 22 cases with squamous cell carcinoma, 4 cases with adenocarcinoma, 3 cases with carcinoma in situ, and 1 case with adenosquamous carcinoma. The maximum standard uptake (SUVmax) value was (10.36±5.22), and the patient’s lesions showed different degrees of increase of 18F-FDG metabolism. The necrotic area in the patient's lesion showed reduced/defect metabolism. The sensitivity of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer was 86.66%, specificity was 44.44%, and accuracy was 76.92%. In the 32 cases followed up for monitoring after the operation, 16 cases showed recurrence, metastasis, residual and other conditions, and 7 cases showed local recurrence/metastasis. 18F-FDG PETCT images showed: abnormal widening of the cervix, stump nodules/mass in the vagina, and rectal and bladder infiltration. All patients with local recurrence were treated with local tissue biopsy or surgical resection under 18F-FDG PETCT image localization. The diagnostic sensitivity, specificity and diagnostic coincidence rate of 18F-FDG PETCT imaging for postoperative follow-up of cervical cancer patients were 100%, 75.00% and 87.50%, respectively.ConclusionsFor patients with cervical cancer who are initially diagnosed or followed up, they can all be tested by 18F-FDG PETCT imaging, which can provide a reference for the formulation of diagnosis and treatment plan and the evaluation of prognosis.

MLsurvival: an automated machine learning tool for survival analysis of cancer patients.

e13555 Background: Survival analysis is used to establish a connection between covariates and the time of event with censored data. Compared with traditional statistical methods, machine learning approaches based on sophisticated and effective computational algorithms are more capable for handling complex multi-dimensional medical data. Methods: We developed an automated machine learning tool MLsurvival to analyze survival data of cancer patients, algorithms of which include the statistical cox regression and machine learning based on linear model (elastic net), ensemble model (gradient boosting with least squares or regression trees and random forest) and support vector kernel (linear and non-linear). The workflow of MLsurvival is comprised with four modules: preprocessing (missing data remove or imputation and feature standardization), feature selection (unsupervised multi-statistics and supervised machine recursive feature elimination with cross-validation), modeling (hyperparameter and performance evaluation) and prediction. To evaluate the performance of this tool, we analyzed medical data for 222 hepatocellular carcinoma (HCC) patients at stage II-III who underwent surgical resection and developed five machine learning approach based estimation models for overall survival (OS). Models were trained on 155 patients with 300 features, including clinical information, somatic mutation and copy number variation, and independently validated on the rest 67 patients. Results: The ensemble model of gradient boosting fitted by MLsurvival using 48 selected features for the data of 155 HCC patients possessed the highest mean AUC and C-Index value. For 67 patients in validation set, this model predicted half year mortality of patients with an AUC of 0.9 (95% CI, 0.771-1.029) and one year mortality with an AUC of 0.897 (95% CI, 0.816-0.978). In addition to that, this model was also predictive for the time of recurrence (pvalue &lt; 0.0001). Furthermore, we also utilized this tool in survival analysis for extensive real data from patients with breast, lung, and esophagus cancers, while most of results showed superior accuracy and stable performance. Conclusions: MLsurvial is an automate tool for survival analysis of cancer patients with well performance. The risk scoring system implemented in this tool offers a novel strategy for incorporating multi-dimensional risk factors to predict clinical outcome, contributes to the better understanding of disease background and helps to optimize the clinical follow-up and therapeutic treatment for cancer patients.

Combining Superpixels and Deep Learning Approaches to Segment Active Organs in Metastatic Breast Cancer PET Images.

Semi-automatic measurements are performed on 18FDG PET-CT images to monitor the evolution of metastatic sites in the clinical follow-up of metastatic breast cancer patients. Apart from being time-consuming and prone to subjective approximation, semi-automatic tools cannot make the difference between cancerous regions and active organs, presenting a high 18FDG uptake.In this work, we combine a deep learning-based approach with a superpixel segmentation method to segment the main active organs (brain, heart, bladder) from full-body PET images. In particular, we integrate a superpixel SLIC algorithm at different levels of a convolutional network. Results are compared with a deep learning segmentation network alone. The methods are cross-validated on full-body PET images of 36 patients and tested on the acquisitions of 24 patients from a different study center, in the context of the ongoing EPICUREseinmeta study. The similarity between the manually defined organ masks and the results is evaluated with the Dice score. Moreover, the amount of false positives is evaluated through the positive predictive value (PPV).According to the computed Dice scores, all approaches allow to accurately segment the target organs. However, the networks integrating superpixels are better suited to transfer knowledge across datasets acquired on multiple sites (domain adaptation) and are less likely to segment structures outside of the target organs, according to the PPV.Hence, combining deep learning with superpixels allows to segment organs presenting a high 18FDG uptake on PET images without selecting cancerous lesion, and thus improves the precision of the semi-automatic tools monitoring the evolution of breast cancer metastasis.Clinical relevance- We demonstrate the utility of combining deep learning and superpixel segmentation methods to accurately find the contours of active organs from metastatic breast cancer images, to different dataset distributions.

Follow-Up of Head and Neck Cancer Survivors: Tipping the Balance of Intensity.

The traditional concept of post-treatment surveillance in head and neck cancer patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and medical oncologists. Emerging evidence underscores the importance of monitoring and effective management of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the current evidence-based medicine, follow-up of head and neck cancer patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal cancer tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the lungs, can be successfully salvaged by local ablation, either surgically or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some cancer survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

Assessment of myocardial extracellular volume on body computed tomography in breast cancer patients treated with anthracyclines.

Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time. After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection. Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values. mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow.

Non-coding RNAs as Putative Biomarkers of Cancer-Associated Cachexia.

Cachexia is a complex metabolic syndrome that determines a severe body weight loss characterized by a marked reduction in muscle mass. About 80% of patients with advanced cancer develop cachexia due to both the tumor itself and cancer treatment (radiotherapy and/or chemotherapy), which is associated to a worse prognosis. Despite its clinical relevance, this syndrome is still under-diagnosed and it lacks effective treatments. Radio-chemotherapy treatment is essential in patients with advanced head and neck cancers (HNSCC). Although this treatment has improved patients’ life expectancy, it has also dramatically increased their need for assistance and support. The management of adverse symptoms, including cachexia, is of great importance in order to avoid delays in therapy, reduction of dosages and hospitalizations. MicroRNAs (miRNAs) are small non-coding RNA molecules, which have emerged as powerful biomarkers in stratifying human cancers. Due to their high stability in body fluids, miRNAs might be excellent non-invasive biomarkers for the early detection and follow-up of cancer patients. Here, we will summarize the current knowledge and debate the strong need to identify circulating biomarkers for the early diagnosis of cachexia. We will propose circulating non-coding RNAs as biomarkers for detecting early cachexia and implementing specific treatment. We will also discuss the potential use of circulating miRNAs as biomarkers of cachexia in HNSCC patients’ blood samples collected before and after radio-chemotherapy treatment. Our intent is to pave the way to the identification of specific circulating miRNAs associated to cachexia occurrence and to the design of specific interventions aimed at improving the quality of life of cancer patients.

Transcriptomics in cancer revealed by Positron Emission Tomography radiomics

Metabolic images from Positron Emission Tomography (PET) are used routinely for diagnosis, follow-up or treatment planning purposes of cancer patients. In this study we aimed at determining if radiomic features extracted from 18F-Fluoro Deoxy Glucose (FDG) PET images could mirror tumor transcriptomics. In this study we analyzed 45 patients with locally advanced head and neck cancer (H&N) that underwent FDG-PET scans at the time of diagnosis and transcriptome analysis using RNAs from both cancer and healthy tissues on microarrays. Association between PET radiomics and transcriptomics was carried out with the Genomica software and a functional annotation was used to associate PET radiomics, gene expression and altered biological pathways. We identified relationships between PET radiomics and genes involved in cell-cycle, disease, DNA repair, extracellular matrix organization, immune system, metabolism or signal transduction pathways, according to the Reactome classification. Our results suggest that these FDG PET radiomic features could be used to infer tissue gene expression and cellular pathway activity in H&N cancers. These observations strengthen the value of radiomics as a promising approach to personalize treatments through targeting tumor-specific molecular processes.

Longitudinal trial of smart-phone based social media applications for remote monitoring of cancer patients in the context of a LMIC: compliance, satisfaction, and cost-benefit analysis

The cancer burden is expected to reach 20 million new cases annually in low and middle-income countries (LMICs) by 2025. Few estimates suggest that thyroid cancer could become the third most common cancer diagnosed in women by 2019. Health care services need to gear up to provide close clinical follow-up care for patients especially in LMICs where there is already a shortage of healthcare personnel. We conducted this study to assess the effect of remote monitoring using tele-follow up on compliance, satisfaction and economic benefit. Participants were recruited to traditional hospital follow-up (consultation, clinical examination, and investigations as per hospital policy) or tele-follow up based on social media. Outcomes included information needs, participants’ compliance, and satisfaction, post-op complications, clinical investigations ordered. A total of 64 patients with thyroid cancer were recruited- 24 in hospital follow up group and 40 in the remote monitoring group. There were no significant differences between groups regarding satisfaction with information received. Responses were significantly more positive in the social media group, with a higher percentage reporting “very satisfied”. Wound evaluation through tele-follow up was on par with OPD follow up. If all of these 40 patients would have come to our OPD follow-up, they would have travelled on an average of 930 kms per patient. This study shows that social media is a practical tool in follow-up of cancer patients in LMICs where traditional telemedicine tools are restricted and conventional follow-up is economically challenging to patients. It also ensures compliance which is a major issue with conventional follow-up due to poor infrastructure.

Genetic Counseling in the Follow-up of Breast Cancer patients; Conversion of a Luminal Tumor to TNBC

Background: Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial. Case presentation: A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences.Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors?Conclusion: There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Re-assessing the specimen for ER, PR, and HER-2 is necessary for this setting.

Physical imaging phantoms for simulation of tumor heterogeneity in PET, CT, and MRI: An overview of existing designs.

BackgroundIn oncology, lesion characterization is essential for tumor grading, treatment planning, and follow‐up of cancer patients. Hybrid imaging systems, such as Single Photon Emission Computed Tomography (SPECT)/CT, Positron Emission Tomography (PET)/CT, or PET/magnetic resonance imaging (MRI), play an essential role for the noninvasive quantification of tumor characteristics. However, most of the existing approaches are challenged by intra‐ and intertumor heterogeneity. Novel quantitative imaging parameters that can be derived from textural feature analysis (as part of radiomics) are promising complements for improved characterization of tumor heterogeneity, thus, supporting clinically relevant implementations of personalized medicine concepts. Nevertheless, establishing new quantitative parameters for tumor characterization requires the use of standardized imaging objects to test the reliability of results prior to their implementation in patient studies.MethodsIn this review, we summarize existing reports on heterogeneous phantoms with a focus on simulating tumor heterogeneity. We discuss the techniques, materials, advantages, and limitations of the existing phantoms for PET, CT, and MR imaging modalities.ConclusionsFinally, we outline the future directions and requirements for the design of cross modality imaging phantoms.

Comparison between CT and MRI in detection of metastasis of the retroperitoneum in testicular germ cell tumors: a prospective trial

Introduction: To minimize the radiation exposure of mostly young testicular cancer patients, it is essential to find out whether CT could be replaced by magnetic resonance imaging (MRI) in the staging and follow-up of the patients. In this trial, we examined whether abdominal MRI is as effective as computed tomography (CT) in the detection of retroperitoneal metastases of testicular cancer.Material and methods: This prospective study included 50 patients, 46 cases of retroperitoneal metastases and 4 controls without abdominal metastases (mean age 33, 5 years, range 20–65 years). Imaging of the retroperitoneum was performed using CT and 1.5 T MRI with diffusion weighted imaging (DWI). One experienced radiologist re-analyzed all of the examinations without knowledge of clinical information. All metastatic or suspicious lymph nodes were noted and measured two-dimensionally from axial images. Nodal detection and the size of detected nodes on CT and MRI were compared.Results: There was no significant difference in the detection of retroperitoneal metastasis between CT and MRI. The sensitivity of MRI was 0.98. There was no statistically significant difference in the sizes of lymph nodes found in CT and MRI, and even very small lymph nodes could be detected in MRI as well as in CT.Conclusion: MRI with DWI is as good as CT in detection of retroperitoneal lymph node metastases regardless of lymph node size, and it can be used as part of follow-up of testicular cancer patients instead of ionizing radiation producing imaging methods.

The course of symptoms of anxiety and depression from time of diagnosis up to 2years follow-up in head and neck cancer patients treated with primary (chemo)radiation.

To identify sociodemographic and clinical factors, health-related quality of life (HRQOL) and head and neck cancer (HNC) symptoms associated with the course of symptoms of anxiety and depression from pretreatment to 24-month follow-up among HNC patients after (chemo)radiation. Patients (n=345) completed questionnaires on anxiety and depression (HADS), HRQOL and symptoms (EORTC QLQ-C30/QLQ-H&N35) before treatment, and 6-weeks,3-,6-12-,18-, and 24-months after treatment. Mixed model analyses were used to investigate the course of anxiety and depression from pretreatment to 24-months in relation to factors assessed at baseline, and the course of anxiety and depression from 6- to 24-months, in relation to factors assessed at 6-months. Increased risk for anxiety (HADS-anxiety>7) was 28.7% among patients before treatment, which declined to 10.0% at 24-months. Increased risk for depression (HADS-depression>7) was 15.1% before treatment, 18.2% at 3-months, 7.2% at 12-months and 16.0% at 24-months. Factors assessed at baseline which were significantly associated with the course of anxiety were age, pain, problems with social contact, and feeling ill, whereas chemotherapy, worse emotional functioning, speech problems and weight loss were significantly associated with the course of depression. Regarding factors assessed at 6-months, chemotherapy, worse cognitive and social functioning, insomnia, swallowing problems and trouble with social eating were associated with the course of anxiety. Nausea/vomiting, dyspnea, coughing, and feeling ill were associated with the course of depression (p-values<0.05). Factors associated with a worse course of anxiety and depression are younger age, treatment with chemotherapy, worse HRQOL and higher symptom burden.

Long term follow-up of rectal cancer patients with a complete response followed in a Wait-and-See approach, is there an increased risk for metastasis?

Background: Patients with a regrowth in a wait-and-see-program are reported to have a higher risk for metastases. This is probably related to an inherent higher risk of incomplete responders, but it cannot be excluded that metastases can arise from the regrowth. The aim of this study was to evaluate the risk of distant metastasis in wait-and-see patients with a clinical(near)complete response (cCR) after neoadjuvant chemoradiation (CRT) for rectal cancer, according to local regrowth and timing of inclusion.

Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer

IntroductionSurgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the post- radiotherapy period is improved. ObjectiveThe role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. MethodsA total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients’ age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. ResultsRecurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). ConclusionsMagnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Assessment of symptoms, quality of life and associated costs in a one-month follow-up of cancer patients with breakthrough pain: The IMDI Study

Purpose: Breakthrough Pain (BTP) observed in up to 66% of cancer patients, is more common in patients with advanced cancer stages and is usually associated with a poor prognosis.

The Feasibility and Effects of Qigong Intervention (Mind-Body Exercise) in Cancer Patients With Insomnia: A Pilot Qualitative Study

Background:Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia.Methods:Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8 weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up.Results:Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly (P < .05).Conclusion:This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials.Trial registration:The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001670268) http://www.ANZCTR.org.au/ACTRN12618001670268.aspxon10October2018.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 1): AN UPDATE ON DIAGNOSIS, STAGING, ENDOSCOPIC TREATMENT AND FOLLOW-UP.

ABSTRACT Background: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. Methods: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. Conclusion: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.

Comparative study of bilateral axillo-breast approach endoscopic and robotic thyroidectomy: propensity score matching analysis of large multi-institutional data.

PurposeThe aim of this study was to compare the large multi-institutional data of surgical outcomes of bilateral axillo-breast approach (BABA) robotic (RT) and endoscopic thyroidectomy (ET) and to evaluate the merits of robotic thyroidectomy.MethodsFrom 2004 to 2015, 1,029 patients underwent BABA ET, and from 2008 to 2015, 2003 patients underwent BABA RT in 3 large volume centers in Korea. Two groups were retrospectively compared in terms of clinicopathologic characteristics, complications, surgical completeness, and long-term outcomes using propensity score matching analysis.ResultsBoth groups had similar demographic characteristics including age, sex, tumor size, pathologic stage, and hospital stay after matching. Each group had similar rate of transient hypoparathyroidism, however, ET showed significantly higher rate of permanent hypoparathyroidism (ET 5.2% vs. RT 2.3%, P = 0.05), and transient vocal cord palsy (ET 14.4% vs. RT 9.1%, P = 0.006). Total operation time was longer in the ET group irrespective of surgical extents, including lobectomy (P = 0.016), total thyroidectomy (P = 0.031), and total thyroidectomy with central lymph node dissection (P = 0.019). The rate of patients with off-Tg under 1.0 ng/mL after 1st ablation was significantly higher in RT than ET group (ET 64.6% vs. RT 92.7%, P < 0.001). In long-term follow-up of cancer patients, 1.4% experienced recurrence after ET (10 cases), while 0.3% cases experienced recurrence after RT (5 cases) (P < 0.001).ConclusionBoth ET and RT can be safe and effective methods to treat thyroid diseases. However, the application of robotic system may help to overcome the limitations of the instruments and surgeon's skills.