Second cancer (SCa) risk among patients (pt) treated with abdomino-pelvic radiation (XRT) for epithelial ovarian cancer (EOC).
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e16535 Background: Prior studies suggest a survival benefit of adjuvant abdomino-pelvic XRT for the treatment of low stage, non-serous EOC. However, the long-term risk of a SCa from XRT is unknown. We examined the relationship between XRT use and the risk of SCas in a population-based cohort of EOC pt. Methods: We determined the rates of SCa in a previously described cohort of stage I-III (microscopic residual only) EOCs, diagnosed between 1984-2008 and treated with adjuvant chemotherapy +/-XRT(45 Gray to abdomen and pelvis) at any of 5 regional Cancer Centers in British Columbia. SCas were any non-skin cancer(ca) diagnosed > / = 12mo after the primary EOC. The site of SCa relative to the XRT field was determined by a radiation oncologist(in-field/field border/out-of-field)(CH). Cox regression accounting for age, stage and histotype comparing XRT vs. no XRT was used to determine the hazard for developing SCa as the event of interest. Competing risk analysis was carried out looking at either SCa or death due to XRT. Results: 703 pts were included in the analysis: median age 56 years (yrs)(range 25-89), 38% stage I, 44% stage II and 18% stage III, 37% high grade serous ca (HGSC), 25% endometrioid ca, 22% clear cell ca, 10% mucinous ca and 6% unknown. 351(49.9%) pt received XRT, while 352(50.1%) did not. XRT was associated with a longer median survival (14.1 vs 8.3 yrs,p < 0.0001). Median time to SCa was 8.4 yrs overall. The rate of SCa was 15%(53 pt) with and 10%(34 pt) without XRT, p = 0.04. Among pt who had XRT, 45% of SCas were in-field, 36% out-of-field, 11% along the field border and the remaining unknown. There was no difference in time to SCA between in-field/border vs. out-of-field SCa(p = 0.292). Cox regression analysis revealed no significant difference in the risk of SCa according to XRT use(HR 1.21,95%CI,0.77-1.90,p = 0.40). There was no increased risk of SCa on the basis of EOC histotype. Competing risk analysis did not demonstrate a significant increase in cumulative incidence of SCa due to XRT, p = 0.26. Conclusions: In this population-based cohort of low stage EOCs, XRT was not associated with a higher risk of SCAs. This study is limited by the small sample size and relatively short median follow up.Central serous chorioretinopathy (CSC) usually occurs in middle-aged people aged 40–50 years, more often in men than women. Most CSC patients are affected unilateral, but there are also bilateral cases. CSC is characterized by serous retinal detachment in the macula.
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Present concept of central serous chorioretinopathy classification does not reflect the true picture of the pathological process. The purpose of the study was the development of diagnostic criteria of central serous chorioretinopathy clinical forms and basing on that extend and optimize its classification with assessment of risk factors and prognosis of disease. Full ophthalmologic and somatic examination of 56men with central serous chorioretinopathy was made. Focal laser coagulation was performed in patients with fluorescein leakage and local injury of pigment epithelium by angiographic data (22patients). In the case of extended damage of pigment epithelium and diffuse leakage of fluorescein (23people) transpupillary thermotherapy of optical disk was conducted. Detailed expert evaluation of retinal changes by fluorescein angiographic data allowed dividing the patients into 3groups. The main criterion for the division was the damaged area of the pigment epithelium: group 1 – central serous chorioretinopathy with local injury of pigment epithelium (with leakage point); group 2 –central serous chorioretinopathy with extensive damage of pigment epithelium with diffuse leakage; group 3 –central serous chorioretinopathy with extensive damage of pigment epithelium combined with leakage point (recurrence of leakage).The results of our study brought us to the following conclusion. Development of new classification criteria of the disease allows to construct a more specific algorithm of therapeutic measures and to determine prognosis of central serous chorioretinopathy already at the stage of diagnostics.
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A number of 7 cases of association of pigment epithelial serous detachment with central serous chorioretinopathy were described. The dye leakages were located at the periphery of the serous detachment (6 cases) and on its anterior surface (1 case). These are due to RPE breaking, as a result of the tension exerted by the build up of choroidal exudate în the subretinal space. Given the circumstances, central serous chorioretinopathy is an atypical clinical type, subsequent to the alterations of the overlying pigment epithelium. This one is differing from the classic type, because of the wide area of the serous detachment and the peripheral location of the dye leakages.
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The degranulation and regranulation process was investigated after α-adrenergic stimulation on the rat submandibular gland. The submandibular gland in rat contains both serous and mucous cells. It has earlier been shown that serous cells filled with heavy-metal granules, are markedly more radiosensitive than cells without granules. In experiments with emptying the serous cell of their content of granules by administering an α-adrenergic stimulant, cyclocytidine, there has been found a decrease in irradiation damage in salivary gland tissue after irradiation. Injection of cyclocytidine, 150 mg/kg, was given i.p. to the rat. After 1 h there was almost complete depletion of granules in the serous cells, no morphological aberration was seen in the mucous cells. This effect still remained after 6 h. A beginning of regranulation with apical granules was seen 12 h after injection. After 24 h an almost complete regranulation had occurred in the salivary gland serous cells. The mucous cells did not show any morphological aberration. Our intent is to reduce unwanted salivary gland damage in patients with head and neck cancer when treated with radiotherapy. Depletion of heavy-metal granules in serous cells, before irradiation may diminish morphological destruction in the salivary glands. As a nearly total degranulation is present between 1–6 h after stimulation, this should be the optimal time for radiotherapy.
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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Dear Sir, We read with great interest the article titled "Traumatic central serous chorioretinopathy" by Steeples et al.[1] It is an interesting case of central serous chorioretinopathy developing after blunt trauma in a young 44-year-old Polynesian male patient. However, we would like to highlight the fact that this patient already had a preexisting history of central serous chorioretinopathy in the other eye probably secondary to his type A personality, which is said to be a predisposing factor for developing central serous chorioretinopathy secondary to increased endogenous corticosteroid levels.[2] In the case reported, the patient was already predisposed to developing central serous chorioretinopathy and the blunt trauma sustained by him could possibly have caused an increased stress level, and thereby leading to enhanced endogenous corticosteroid level and precipitating central serous chorioretinopathy, which possibly is unrelated to blunt trauma directly as the cause of the serous retinal detachment. Financial support and sponsorship Nil. Conflicts of Interest There are no conflicts of interest.
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We present cases of two patients who were examined in our department with the diagnosis of epitheliopathy following treatment with oral and topical glucocorticoids. They were referred because of loss of visual acuity. The ophthalmic examination established the diagnosis of central serous chorioretinopathy and it was decided to stop treatment with glucocorticoids.The pathogenesis of the central serous chorioretinopathy is still imprecisely known, but it has been related to several situations characterized by exposure to high levels of endogenous or exogenous glucocorticoids. Both of these cases provide more evidence of the potential association between corticosteroids and the acute manifestations of central serous chorioretinopathy.
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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