Indiana University-Purdue University Indianapolis (IUPUI) / Endometrial cancer is the most common gynecologic cancer in the United States, and patients with early-stage endometrioid adenocarcinoma have a favorable prognosis. Over the past decade, the gynecologic oncology community has debated whether potential harms of systematic lymph node dissection (LND) outweigh potential benefits for these patients. To minimize number of nodes removed, sentinel lymph node dissection (SLND) is under investigation as an alternative. However, ongoing uncertainty of LND/SLND best practices may result in variations in disease management and discrepant outcomes. Methods Three retrospective cohort studies examined LND/SLND use in patients with endometrioid adenocarcinoma. Two examined temporal and geographic variations, respectively, utilizing the Surveillance, Epidemiology, and End Results (SEER) 18 dataset for the years 2004 through 2015. The third used the SEER-Medicare dataset from 2003 through 2016 to quantify and compare the risk of developing 6-month post-surgical lymphedema, lymphocele, hemorrhage, ileus, infection, thrombosis, and all-cause death by number of lymph nodes removed (0, 1-4, 5-9, or 10+). Results Time trend analyses found LND increased from 2004 through 2008, followed by a significant decline through 2015. SLND was rare and did not increase significantly. Significant geographic variation existed for LND use but not SLND. Per 1,000 patients, analyses of 6-month post-surgical complications found 6.5 experienced lymphedema, 3.9 experienced lymphocele, 15.7 experienced hemorrhage, 28.7 experienced ileus, 37.1 experienced infection, 18.6 experienced thrombosis, and 19.8 died. Controlling for size of primary tumor, tumor grade, comorbidities, race/ethnicity, age at diagnosis, adjuvant chemotherapy, and radiotherapy, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) showed greater risk for ileus (HR: 1.53; 95% CI: 1.24-1.90), infection (HR: 1.52; 95% CI: 1.25-1.83), and thrombosis (HR: 1.41; 95% CI: 1.09-1.82) when comparing removal of 10+ nodes versus 0 nodes. Conclusion Overall, these studies found significant temporal and geographic variation in LND, as well as increasing risk of post-surgical complications associated with increasing numbers of lymph nodes removed. Should continued research into SLND find strong evidence that it effectively detects cancer spread, patients may benefit through decreased risk of post-surgical ileus, infection, and thrombosis.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2011. / To determine the incidence, risk factors and the treatment of lymphedema after breast cancer treatment at the oncology unit of KATH, Kumasi, Ghana from 01 January 2005 to 31 December 2008. Descriptive retrospective survey was used. Using a data capture sheet, data was collected from the medical records of the breast cancer patients. Breast cancer and lymphedema-related variables were collected. Data was analyzed as descriptive statistics. Chi-square test was applied to determine whether or not two variables are independent variables. Among 313 patients treated for breast cancer between 2005 and 2008, 31 (9.9%) developed lymphedema after treatment. A chi-square test showed that axillary lymph node dissection was statistically a significant risk factor of lymphedema (Chi-square test value=7.055, P value=0.008). Radiation and late stage of breast cancer diagnosis may have contributed in development of lymphedema despite having P value> 0.05. Age, body mass index (BMI) and hypertension were also not associated with lymphedema.

Aims: To describe use of post-operative radiation for endometrial cancer in Ontario. To identify system-related and patient-related factors affecting access to this treatment. Materials and Methods: We performed a retrospective population-based cohort study of patients with surgically resected endometrial cancer in the Canadian province of Ontario between 1992-2003. Patients with evidence of incurable cancer at diagnosis or previous cancer diagnosis were excluded. We used multiple logistic regression to assess patient and system factors affecting radiation use. We controlled for disease-related and treatment-related factors: histology, surgical staging, type of hysterectomy and peritoneal biopsy. We applied a mixed model to account for clustering of data by operating hospital. Results: 9,411 women comprised the study cohort. The median age was 63 years. 26.2% received adjuvant radiation. The proportion of patients receiving radiation varied between cancer centre catchment areas from 18.0% to 34.3% (median 26.3%). In multivariate analysis, older patients were more likely to receive radiation up to the age of 80 (p<.0001). Patients who lived further from regional cancer centres were less likely to receive radiation (p=.0210). Patients who had their surgery during longer prevailing wait times at regional cancer centres were less likely to receive radiation (p=.0441). There was a 2.7-fold variation in the odds of radiation use between cancer centre catchments (p<.0001). Management at a comprehensive gynecologic oncology centre was associated with use of radiation for patients who had surgical staging of lymph nodes. Year of diagnosis and neighborhood income quintile did not significantly affect the use of radiation. Conclusions: There is wide variation in use of radiation for endometrial cancer in Ontario. There is evidence that system factors unrelated to patient’s needs affect use of adjuvant radiation for endometrial cancer in Ontario. Age is a key patient-related factor affecting radiation use. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-07 22:02:37.308

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24281号 / 医博第4897号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森田 智視, 教授 妹尾 浩, 教授 波多野 悦朗 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24831号 / 医博第4999号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本, 洋介, 教授 武藤, 学, 教授 永井, 純正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Prostate cancer (PCa) is the most common non-skin malignancy of men in developed countries. In spite of treatment with curative intent up to 30-40% of patients have disease recurrence after treatment, resulting from any combination of lymphatic, hematogenous, or contiguous local spread. The concept of early detection of PCa offer benefits in terms of reduced mortality, but at the cost of over-diagnosis and overtreatment of indolent disease. This is largely due to the random nature of conventional biopsies, with a risk of missing significant cancer and randomly hitting indolent disease. In the present thesis, diagnostic performance of MRI DWI and 11C Acetate PET/CT lymph node staging of intermediate and high risk PCa, was investigated, and additionally, predictive factors of regional lymph node metastases were evaluated. Further, additional value of targeted biopsies to conventional biopsies, for detection of clinically significant PCa, was investigated. In paper one and two, 53 and 40 patients with predominantly high risk PCa underwent 11C Acetate PET/CT and 3T MRI DWI, respectively, for lymph node staging, before extended pelvic lymph node dissection (ePLND). The sensitivity and specificity for PET/CT was 38% and 96% respectively. The sensitivity and specificity for MRI DWI was 55% and 90% respectively. In paper three, 53 patients with newly diagnosed PCa were included. All patients underwent multi-parametric MRI, followed by two cognitive targeted biopsies. Five more clinically significant cancers were detected by adding targeted biopsies to conventional biopsies. In paper four the value of quantitative and qualitative MRI DWI and 11C Acetate PET/CT parameters, alone and in combination, in predicting regional lymph node metastases were examined. ADCmean in lymph nodes and T-stage on MRI were independent predictors of lymph node metastases in multiple logistic regression analysis. In conclusion the specificity of diffusion weighted MRI and 11C Acetate PET/CT for lymph node staging was high, although the sensitivity was low. Predictive factors of regional lymph node metastases could be retrieved from diffusion weighted MRI and 11C Acetate PET/CT. By combining targeted biopsies with conventional biopsies the detection rate of clinically significant PCa could be increased.

No description available.

Orientador: Luís Otávio Zanatta Sarian / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:24:57Z (GMT). No. of bitstreams: 1 Matheus_CarolinaNascimben_D.pdf: 2850729 bytes, checksum: fd170a425e039c6e8f1324b637393c8b (MD5) Previous issue date: 2015 / Resumo: Objetivo: Esta tese visou avaliar os parâmetros vasculares arteriais e venosos dos vasos axilares e braquiais em mulheres submetidas a tratamento para câncer de mama. Subdividimos estas avaliações conforme os objetivos abordados em duas publicações, respectivamente: 1) Comparar aos parâmetros de circulação venosa e arterial nos vasos axilares e braquiais em função do tipo de abordagem cirúrgica da axila (BLS ou LAT) em até seis meses após a intervenção. 2) Identificar os fatores que influenciam os parâmetros vasculares da veias axilares e braquiais ipsilaterais à cirurgia para tratamento do câncer de mama. Métodos: Foram identificadas 547 pacientes consecutivas, submetidas a tratamento cirúrgico para câncer de mama entre agosto de 2012 e janeiro de 2014. Depois de seguir critérios de inclusão e exclusão, 197 mulheres foram recrutadas. O projeto foi aprovado pelo comitê de ética do hospital e todos os pacientes assinaram o termo de consentimento informado. Os critérios de inclusão foram 1) câncer da mama primário operável 2) abordagem axilar cirúrgica; 3) não ter sido submetida a reconstrução da mama. Os critérios de exclusão foram 1) câncer de mama bilateral, 2) história prévia de procedimentos cirúrgicos para um dos membros superiores ou no tórax, 3) comprometimento ortopédico ou neurológico de um dos membros superiores, 4) insuficiência renal ou cardíaca. Todas as pacientes responderam a um breve questionário sobre suas características clínicas e epidemiológicas. Foi então realizada avaliação ultrassonográfica dos vasos braquiais e axilares, bilateralmente, nos seguintes momentos: no dia anterior à cirurgia e 1, 3, 6 e 12 meses após a cirurgia. No primeiro artigo, comparamos os parâmetros arteriais e venosos, até seis meses após a cirurgia, em função da realização de dissecção linfática completa ou linfonodo sentinela; no segundo, restringimos as análises ao sistema venoso e estendemos a avaliação para até 1 ano após a cirurgia, comparando os parâmetros vasculares em função de características clínicas e epidemiológicas das pacientes e das modalidades de tratamentos utilizados. Resultados: Foram encontradas restrições de diâmetro em veias do braço ipsilateral ao câncer de mama de mulheres submetidas à dissecção axilar (LAT), efeito que não foi observado no grupo BLS. A área da secção transversal de veias braquial e axilar diminuiu progressivamente até seis meses, com a redução do fluxo sanguíneo concomitante destes vasos. Encontramos, na mulher sem linfedema, que a área de secção transversal e fluxo venoso do sangue (especialmente veia braquial) são negativamente afetados pela cirurgia e / ou quimioterapia / radioterapia. Este efeito prejudicial parece persistir até um ano. Não houve diferença significativa em nenhum dos parâmetros estudados entre os vasos ipsi e contralaterais ao câncer de mama. Conclusões: De maneira geral, nosso estudo demonstra que os tratamentos cirúrgicos, especialmente LAT, e a radio e quimioterapia, possuem efeitos deletérios sobre a circulação sanguínea dos vasos axilares e braquiais, sobretudo venosos. Esses efeitos são aparentemente permanentes e há necessidade de extensão do tempo de follow-up a fim de avaliar se o desenvolvimento subsequente de linfedema ocorrerá em associação às alterações vasculares / Abstract: Objective: The aim of this thesis was to evaluate the arterial and venous vascular parameters of the axillary and brachial vessels in women who underwent treatment for breast cancer. We subdivided these assessments according to the following objectives, in two publications: 1) To compare the venous and arterial vascular parameters in the axillary vessels and brachial depending on the type of axillary surgical approach (SLNB or ALND) within six months after the intervention. 2) To identify which factors influence the vascular parameters of axillary and brachial veins ipsilateral to surgical for treatment of breast cancer. Methods: We identified 547 consecutive patients undergoing surgical treatment for breast cancer between August 2012 and January 2014. After following inclusion and exclusion criteria, 197 women were recruited. The project was approved by the hospital's ethics committee and all patients signed an informed consent form. Inclusion criteria were 1) primary operable breast cancer 2) surgical axillary approach; 3) not having undergone breast reconstruction. Exclusion criteria were 1) bilateral breast cancer, 2) history of previous surgical procedures for one of the upper limbs or breast, 3) orthopedic or neurological impairment of one upper limb, 4) kidney or heart failure. All patients completed a brief questionnaire about their clinical and epidemiological characteristics. Then we performed Doppler ultrasonography evaluation of axillary and brachial vessels, bilaterally, at the following times: the day before surgery and 1, 3, 6 and 12 months after surgery. In the first article, we compared the arterial and venous parameters, up to six months after surgery, depending on SLNB or ALND; in the second, we restricted the analysis to the venous system and extend the evaluation for up to 1 year after surgery, comparing the vascular parameters with clinical and epidemiological characteristics of patients and treatment modalities used. Results: diameter restrictions were found in the ipsilateral veins of the arm in women with breast cancer undergoing ALND, and that effect was not observed in SLNB group. The cross sectional area of brachial and axillary veins progressively decreased up to six months, with concomitant reduction of blood flow to these vessels. In women with no lymphedema, the cross-sectional area and venous blood flow (especially brachial vein) are negatively affected by surgery and / or chemotherapy / radiotherapy. This detrimental effect seems to persist up to one year. There was no significant difference on studied parameters between ipsilateral and contralateral vessels to breast cancer. Conclusions: In essence, our study shows that surgical treatments, especially ALND, and the radiation and chemotherapy, have deleterious effects on blood circulation of the axillary and brachial vessels, especially venous. These effects are apparently permanent, prompting the extension of the follow-up evaluation in order to assess whether subsequent lymphedema formation will be associated with vascular abnormalities / Doutorado / Oncologia Ginecológica e Mamária / Doutora em Ciências da Saúde