Cancer
-
Hospital and surgeon (provider) volume are associated with clinically significant outcomes for many types of surgery. Volume-outcome studies in patients undergoing radical cystectomy for bladder cancer have focused primarily on postoperative mortality. In the current study, the authors assessed the effect of cystectomy provider volume on long-term mortality. ⋯ High-volume providers were associated with improved long-term mortality rates compared with low-volume providers. This finding was independent of the effect of volume on perioperative mortality, suggesting that provider volume effects continue to manifest long after surgery.
-
The prognosis of patients with gastric cancer with peritoneal metastasis is extremely poor. This phase 2 study evaluated the benefits and tolerability of weekly intravenous and intraperitoneal paclitaxel (PTX) treatment combined with oral S-1 in patients with gastric cancer who had macroscopic peritoneal metastasis. ⋯ Combination chemotherapy consisting of intravenous and intraperitoneal PTX with S-1 is well-tolerated and effective in patients with gastric cancer who have macroscopic peritoneal metastasis.
-
Comparative Study
Breast cancer mortality in participants of the Norwegian Breast Cancer Screening Program.
The Norwegian Breast Cancer Screening Program started in 1996. To the authors' knowledge, this is the first report using individual-based data on invitation and participation to analyze breast cancer mortality among screened and nonscreened women in the program. ⋯ After 15 years of follow-up, a 43% reduction in mortality was observed among women who attended the national mammographic screening program in Norway.
-
Comparative Study
Cost-effectiveness of stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer.
The traditional treatment for clearly operable (CO) patients with stage I non-small cell lung cancer (NSCLC) is lobectomy, with wedge resection (WR) and stereotactic body radiation therapy (SBRT) serving as alternatives in marginally operable (MO) patients. Given an aging population with an increasing prevalence of screening, it is likely that progressively more people will be diagnosed with stage I NSCLC, and thus it is critical to compare the cost-effectiveness of these treatments. ⋯ SBRT was nearly always the most cost-effective treatment strategy for MO patients with stage I NSCLC. In contrast, for patients with CO disease, lobectomy was the most cost-effective option.
-
Multicenter Study
Phase 2 trial of afatinib, an ErbB family blocker, in solid tumors genetically screened for target activation.
The efficacy of afatinib, an irreversible ErbB Family Blocker, was evaluated in patients who had 1 of 4 categories of solid tumors with epidermal growth factor receptor/human epidermal growth factor receptor 2 (EGFR/HER2) gene amplification or EGFR-activating mutations. ⋯ Single-agent afatinib activity was limited, yet encouraging, in selected tumors that were screened prospectively for target activation. The implementation of a biomarker-driven approach using a low-frequency biomarker for patient selection across multiple tumor types can be challenging.