This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the relative effects of chemotherapy, surgery, radiotherapy and immunotherapy in the treatment of endemic Burkitt's lymphoma
The Medical Research Council UKALL V trial for children with standard-risk acute lymphoblastic leukemia (ALL) (aged 1 to 14 years, leucocyte count less than 20 X 10(9)/L) was designed to determine whether the immunosuppressive effects of treatment could be reduced without sacrifice of antileukemic effect by alterations in the type of continuing therapy or in fractionation of cranial irradiation. Remission was achieved in 496 children on standard induction therapy, and 309 children received 24 Gy of cranial irradiation in ten to 16 fractions over 21 days, and 174 received 21 Gy in five to nine fractions over 21 days. The type of radiotherapy administered had no influence on relapse at any site or rate of death in remission. All 496 children were randomized to receive chemotherapy for 2 or 3 years with 6-mercaptopurine and methotrexate either as a continuous (group C) or a semicontinuous (group G) regimen or as a five-day pulse every 3 weeks (group I). All groups also received vincristine and prednisolone every 6 weeks. With a minimum follow-up of almost 7 years, patients in group I had significantly fewer remission deaths (P = .025) but a much higher rate of bone marrow relapse than those in group C or G (P = .002). There was an overall benefit for 3 years of chemotherapy compared with 2 years, which in contrast to previous studies, was more apparent in girls and in patients in groups C and G. Testicular relapse occurred in 37 boys, including 19 patients off therapy, with a previously negative biopsy. The overall results confirmed the prognostic significance of initial leucocyte count, even among these standard-risk patients, while girls had a superior rate of disease-free survival, but not of hematologic remission. It is concluded that, even among standard-risk patients, the prognosis is influenced by the height of the initial leukocyte count. While alterations in the fractionation of cranial irradiation do not appear to have influenced disease-free survival, intermittent continuing chemotherapy, although less immunosuppressive, is less effective than conventional continuous therapy in the treatment of ALL. In this study, 3 years of chemotherapy appeared superior to 2 years.
At the commencement of UKALL XI, a national MRC trial for childhood lymphoblastic leukaemia (ALL), the therapy included a bolus of daunorubicin (DR) on the first 2 d of the protocol. This component of treatment was subsequently withdrawn because of concern about long‐term cardiotoxicity. All children both before and after this change of policy had their marrow status at the end of the first week assessed by central review as part of the trial to examine the clinical importance of the rate of disease clearance. This also afforded an opportunity to observe the effect of DR on gross residual disease at an early stage of therapy. 1419 children were studied: 342 received DR (‘recipients’), 1077 did not. 44% of the recipients completely cleared their marrow of blast cells after 8 d compared with 13% of the non‐recipients (χ 2 =158.2, P <0.0001). The difference in the proportion with massive residual disease (>80% blasts) was less impressive but there was still a difference in favour of DR recipients (DR 9%, no DR 15%; χ 2 =7.7, P =0.006). The rate of disease clearance correlated with disease‐free survival for both recipients and non‐recipients, but there was no significant difference in outcome when comparing the two groups with each other, either in terms of disease‐free or relapse‐free survival. DR accelerated the rate of blast cell disappearance from the marrow but the difference this made to disease free survival is small or non‐existent. It appears to be the relative speed of response to a given therapeutic regimen that is prognostically important rather than the absolute rate of response when comparing one treatment with another.
Abstract Objective ENT is underrepresented in the curriculum, and this has been compounded by coronavirus disease 2019. Recent restructures have removed ENT placements from the curriculum. This lack of exposure needs to be addressed, and increased use of online learning represents an opportunity to facilitate this. This study aimed to evaluate whether online learning can effectively deliver undergraduate ENT teaching. Methods An online ENT module was created; content was structured on the Sheffield Medical School curriculum. Pre- and post-module tests and 5-point Likert scales were used to assess student knowledge and confidence, respectively. Results A total of 115 participants were recruited. Test scores improved by 29 per cent ( p < 0.001) and confidence by 66 per cent. Anatomy and ENT conditions demonstrated significant improvement in confidence, with a lower confidence score for examination. Conclusion This study showed improved knowledge and confidence, whilst highlighting greater efficacy in content over practical skills teaching. Online learning is a validated educational tool; however, it should not be used as a replacement but as an adjunct to supplement learning.
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