Cancer
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Comparative Study
Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma.
Primary cutaneous melanoma is often infiltrated lymphocytes that provide the opportunity to study what may be the local immunologic reaction to the tumor and to correlate the presence of these lymphocytes with overall survival. In an attempt to delineate the histologic diagnostic criteria, to classify different categories of lymphocytic infiltrates, previously described by Elder et al. at brisk, nonbrisk, and absent, and to verify their prognostic significance, we reviewed 285 consecutive cases of primary cutaneous melanomas (American Joint Committee on Cancer Stage I and II). ⋯ We demonstrated that when categories of tumor infiltrating lymphocytes are strictly defined, they indeed have very strong predictive value for primary cutaneous melanomas with a vertical growth phase. This work confirms the work of Clark et al. and fully illustrates the brisk, nonbrisk, and absent categories of infiltration. Finally, a multivariate analysis comparing thickness, mitotic rate and presence of tumor infiltrating lymphocytes showed that only thickness and presence of tumor infiltrating lymphocytes are significant and independent positive histologic prognostic factors.
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Comparative Study
Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathology.
An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning as well as for evaluation and comparison of the results of different treatment modalities. Neoplastic invasion of the laryngeal cartilage may have important therapeutic implications. To our knowledge, no data are available comparing the impact of endoscopic examination, computed tomography (CT), and magnetic resonance (MR) imaging on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunct to other clinical examinations in the pretherapeutic staging of laryngeal carcinoma. ⋯ Clinical/endoscopic examination alone failed to identify tumor invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57.5%). Many pT4 (according to the International Union against Cancer TNM Staging System) tumors were clinically unrecognized. The combination of clinical/endoscopic evaluation and an additional radiologic examination, either CT or MR imaging, resulted in significantly improved staging accuracy (80% vs. 87.5%). MR imaging is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR imaging tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and may lead to inadequate therapy.
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Comparative Study
Adjustment of children and adolescents to parental cancer. Parents' and children's perspectives.
Little empirical evidence exists to address the impact of a diagnosis of cancer of a father or mother on his or her children. Previous studies have found inconsistencies in the levels of distress reported for children of a parent with cancer, which may be a function of who (parent or child) was reporting on the child's symptoms and when the reports were taken (near diagnosis or months or years later). ⋯ Children's symptoms of psychologic distress varied considerably according to their age, sex, whether their mother or father had cancer, and whether they themselves or their parents were reporting the symptoms. Adolescent girls whose mothers had cancer reported the highest levels of distress. When children did report elevated levels of psychologic symptoms, their parents did not appear to be aware of their distress and rated their children as asymptomatic. These findings suggest that health professionals may need to assist parents in recognizing and coping with their children's distress when it is present.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of granisetron, ondansetron, and tropisetron in the prophylaxis of acute nausea and vomiting induced by cisplatin for the treatment of head and neck cancer: a randomized controlled trial.
A single-institution, prospective, randomized, open controlled trial was carried out on head and neck cancer patients to compare granisetron (GRA), ondansetron (OND), and tropisetron (TRO) in the prevention of cisplatin-induced acute nausea and vomiting. All patients were chemotherapy-naive and treated with cisplatin on Day 1 (80 to 100 mg/m2). ⋯ Although our results were achieved in an open trial, they show that GRA and OND are equally effective antiemetic agents in the prevention of cisplatin induced acute nausea and vomiting. TRO provides almost the same protection but is not as effective as OND for major efficacy. All three antiemetics can be administered safely to patients undergoing chemotherapy with cisplatin at doses of 80 mg/m2 or more.
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Comparative Study
Teaching cancer pain management: durability of educational effects of a role model program.
Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions. ⋯ Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.