One in 25 patients battling hospital-acquired infections: CDC

By Gene Emery

NEW YORK (Reuters Health) - On any given day, one in 25 hospitalized patients - 4 percent - is battling an infection picked up in a hospital or other healthcare facility, according to a new survey by the Centers for Disease Control and Prevention (CDC).

That translates to more than 600,000 hospital patients each year. Roughly 74,000 of them have to fight more than one hospital-acquired infection, researchers found.

About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery.

Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002.

"The trend, in magnitude, seems to be going in the right direction," Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health.

Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.

The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility.

Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively.

The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular.

Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.

The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year.

The new report "validates the work we've been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures," Bell said.

To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says.

SOURCE: http://bit.ly/1rzGOHe New England Journal of Medicine, online March 26, 2014.

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When experience fewer side effects from breast cancer patients with anti-cancer drugs receive acupuncture treatment

University of Maryland greenebaum cancer new analysis by researchers from the Center for real and fake acupuncture treatment was found to reduce the side effects of the medications commonly used to treat breast cancer. In published early online cancer peer review journal of the American Cancer Society may help to improve clinical cancer patient care. The results also have beneficial effects such as real acupuncture, do raise the question of Sham acupuncture is truly inert.

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Change elevated circulating tumor cell metastasis BC before patients not beneficial chemotherapy.

Women with metastatic breast cancer, after first line chemotherapy in the amount of their blood circulating tumor cell (Ctc) were higher in the immediately switch to another chemotherapy did not improve overall survival or phase III clinical trials, 2013 at the San Antonio Breast Cancer Symposium University of Michigan comprehensive cancer time to progress, according to results announced by researchers in the Center, held 10-14 December.

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Among the patients with CLL trigger Ibrutinib and rituximab 95% response rate

University of Texas MD Anderson Cancer from the Center researchers United States blood of no. 55 times tournament report targeted therapy ibrutinib and antibody rituximab treatment of chronic lymphocytic leukemia patients meet the phase II clinical trials in high-risk almost everything.

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Translate the new findings to enhance treatment of patients with malignant melanoma cancer researchers.

From translational researchers at UCLA's Jonsson Comprehensive Cancer Center (number of days), published results of a study provide insightful journal Cancer found BRAF inhibitor resistance two key areas critical to tumor how two back-to-back: focus and use to learn how to be resistant to melanoma tumor cells inhibitor with cell signal transduction pathway BRAF-mutant, evolve and limited development cell BRAF inhibitor drug resistance is how black keys.

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Work the researchers to improve the outcomes of patients with lymphoma.

University of Nebraska Medical Center （ Fred & Pamela Buffett cancer center headquartered ） of researchers are diffuse large B cell lymphoma patient they discovered that do not respond to standard drug therapy used to treat this type of cancer if you have a high level of gene called STAT3. Findings will be published in medical journal 11 issue of the journal Clinical Oncology, Clinical Oncology, American society.

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HIV protein may impact neurocognitive impairment in infected patients

Nov. 15, 2013 — A protein shed by HIV-infected brain cells alters synaptic connections between networks of nerve cells, according to new research out of the University of Minnesota. The findings could explain why nearly half of all patients infected with the AIDS virus experience some level of neurocognitive impairment.

The research was published in the current volume of the Journal of Neuroscience.

"The synaptic changes didn't appear to be a symptom of nerve death," said Nicholas Hargus, Ph.D., lead author on the paper and a post-doctoral fellow in the Department of Pharmacology in the University of Minnesota Medical School. "Instead, the changes appeared to be a protective response resulting from the over-excitation of the network by the HIV protein transactivator of transcription (Tat). Essentially, the neuroprotective mechanism has gone awry."

HIV-associated neurocognitive disorders (HAND) are an indirect result of HIV, as the disease itself does not infect neurons. Tat has been shown to contribute heavily to the development of HAND in patients. Hargus and Stanley Thayer, Ph.D., professor in the Department of Pharmacology, wanted to learn more about the relationship between Tat and HAND to better understand how to treat the disorders.

Researchers replicated the impact of the Tat in a rat model and tracked the changes to the synaptic proteins. They found changes in both inhibitory and excitatory synapses were initiated by specific Tat binding activity. This discovery indicated a pharmacological change due to exposure to Tat.

"We found drugs altering synaptic transmission between nerve cells reversed the synaptic changes induced by Tat," said Thayer. "In the future, this could provide a target for the development of drugs to act upon and improve cognitive function in patients."

Ongoing experiments are investigating the relationship between drug-induced changes in synaptic connections and the changes in cognitive function. In the future, high throughput approaches to assess synaptic function will be developed for evaluating drug candidates.

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For Argentine chemo patients, mirrors can hurt

BUENOS AIRES, Argentina (AP) — For cancer patients dealing with the physical and psychological trauma of the disease, even looking in the mirror can be difficult. When chemotherapy robs your hair, it's common to feel that a part of your identity goes missing as well.

"Look Good Feel Better" is a program that offers free lessons in makeup and skin care, with tips on covering heads gone bald and using eye-liner to replace fallen eyebrows.

It's an opportunity for beauticians to share their skills, for companies to donate products and for people with cancer to find some hope.

The idea began 25 years ago in the U.S., where more than 700,000 women have participated, and it has spread to Argentina and 23 other countries where chemotherapy is increasingly common. Argentina was the first Latin American nation to launch it, in 1999, and it has since grown to 100 sites across the country.

For Mariela Steinberg, 38, it has made all the difference. She's had multiple surgeries in a yearlong fight with uterine and cervical cancer, and was shocked at first to look in the mirror.

"You see a face but you don't recognize it as your own. But now I can say, little by little, I am beginning to adapt," she said during a two-hour class. "All of a sudden I begin to recognize myself. I am made-up, beautified."

Cancer is the second-leading cause of death in Argentina, after heart disease, and the country's cancer mortality rate is the third highest in Latin America after Cuba and Trinidad and Tobago, the Pan American Health Organization says.

Staying optimistic is known to increase the odds of survival, and appearance can have an outsized impact. Thus the program's theme, "Hope is beautiful."

Daiana Castro, a 23-year-old hairstylist with ovarian cancer, was traumatized at first. "I had red hair, beautiful and long, and when it fell out I didn't leave the house for a week."

Then she sought out one of the classes at Hospital San Martin. "If you have makeup on, you feel better. It helps you not to feel down," Castro said.

Makeup tips include techniques for covering extremely dark circles, creating the impression of eyelashes, drawing on eyebrows where none remain, and wrapping headscarves so they won't slip off smooth skin.

Psychiatric oncologist Gabriela Ozco says the program is a key part of holistic treatments.

"At first, they don't want to look in the mirror," she said. "It's one of the first symptoms that we've noticed with patients. And the fact is that in such workshops one of the first things they do is get them looking in the mirror. So they are faced with, 'This is who I am,' and from there on, it's all about getting better."

___

APTN contributor Kacey Cherry in Buenos Aires helped with this story.

Copyright c 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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New guideline for management of blood cholesterol: Focuses on lifestyle, statin therapy for patients who most benefit

Nov. 12, 2013 — The American College of Cardiology and the American Heart Association today released a new clinical practice guideline for the treatment of blood cholesterol in people at high risk for cardiovascular diseases caused by atherosclerosis, or hardening and narrowing of the arteries, that can lead to heart attack, stroke or death.

The guideline identifies four major groups of patients for whom cholesterol-lowering HMG-CoA reductase inhibitors, or statins, have the greatest chance of preventing stroke and heart attacks. The guideline also emphasizes the importance of adopting a heart-healthy lifestyle to prevent and control high blood cholesterol.

"The new guideline uses the highest quality scientific evidence to focus treatment of blood cholesterol on those likely to benefit most," said Neil J. Stone, MD, Bonow professor of medicine at Northwestern University Feinberg School of Medicine and chair of the expert panel that wrote the new guideline. "This guideline represents a departure from previous guidelines because it doesn't focus on specific target levels of low-density lipoprotein cholesterol, commonly known as LDL, or 'bad cholesterol,' although the definition of optimal LDL cholesterol has not changed. Instead, it focuses on defining groups for whom LDL lowering is proven to be most beneficial."

The new guideline recommends moderate- or high-intensity statin therapy for these four groups:

• Patients who have cardiovascular disease;
• Patients with an LDL, or "bad" cholesterol level of 190 mg/dL or higher;
• Patients with Type 2 diabetes who are between 40 and 75 years of age; and
• Patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age (the report provides formulas for calculating 10-year risk).

In terms of clinical practice, physicians can use risk assessment tools in some cases to determine which patients would most likely benefit from statin therapy, rather than focusing only on blood cholesterol to determine which patients would benefit.

"The likely impact of the recommendations is that more people who would benefit from statins are going to be on them, while fewer people who wouldn't benefit from statins are going to be on them," Dr. Stone said. Doctors may also consider switching some patients to a higher dose of statins to derive greater benefit as a result of the new guidelines.

The guideline was prepared by a panel of experts based on an analysis of the results of randomized controlled trials. The panel was charged with guiding the optimal treatment of blood cholesterol to address the rising rate of cardiovascular disease, currently the leading cause of death and disability in the U.S.

The panel chose to focus on the use of statins after a detailed review of other cholesterol-lowering drugs. "Statins were chosen because their use has resulted in the greatest benefit and the lowest rates of safety issues. No other cholesterol-lowering drug is as effective as statins," said Dr. Stone. He added that there is a role for other cholesterol-lowering drugs, for example, in patients who suffer side effects from statins.

The report also stresses the importance of lifestyle in managing cholesterol and preventing heart disease. "The cornerstone of all guidelines dealing with cholesterol is a healthy lifestyle," said Dr. Stone. "That is particularly important in the young, because preventing high cholesterol later in life is the first and best thing someone can do to remain heart-healthy. On the other hand, if someone already has atherosclerosis, lifestyle changes alone are not likely to be enough to prevent heart attack, stroke, and death, and statin therapy will be necessary."

In addition to identifying patients most likely to benefit from statins, the guideline outlines the recommended intensity of statin therapy for different patient groups. Rather than use a "lowest is best" approach that combines a low dose of a statin drug along with several other cholesterol-lowering drugs, the panel found that it can be preferable to focus instead on a healthy lifestyle along with a higher dose of statins, eliminating the need for additional medications.

"The focus for years has been on getting the LDL low," said Dr. Stone. "Our guidelines are not against that. We're simply saying how you get the LDL low is important. Considering all the possible treatments, we recommend a heart-healthy lifestyle and statin therapy for the best chance of reducing your risk of stroke or heart attack in the next 10 years."

The guidelines are intended to serve as a starting point for clinicians. Some patients who do not fall into the four major categories may also benefit from statin therapy, a decision that will need to be made on a case-by-case basis.

The expert panel that wrote the report was convened by the National Heart, Lung, and Blood Institute of the National Institutes of Health. At the invitation of the NHLBI, the American Heart Association and American College of Cardiology assumed the joint governance, management and publication of this guideline, along with four other prevention guidelines, in June. Committee members volunteered their time and were required to disclose all healthcare-related relationships, including those existing one year before the initiation of the writing project.

The full text of the report, "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults," will be published in future print issues of the of the Journal of the American College of Cardiology and the American Heart Association's journal Circulation. It will also be accessible today on the ACC (http://content.onlinejacc.org/article.aspx?doi=10.1016/j.jacc.2013.11.002) website and AHA (http://circ.ahajournals.org/lookup/doi/10.1161/01.cir.0000437738.63853.7a).

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Longest follow-up of melanoma patients treated with ipilimumab shows some survive up to ten years

Sep. 27, 2013 — Patients with advanced melanoma, who have been treated with the monoclonal antibody, ipilimumab, can survive for up to ten years, according to the largest analysis of overall survival for these patients, presented at the 2013 European Cancer Congress (ECC2013).

Professor Stephen Hodi (MD), Assistant Professor of Medicine at the Dana-Farber Cancer Institute (Boston, USA), told the congress: "Our findings demonstrate that there is a plateau in overall survival, which begins around the third year and extends through to the tenth year.

"These results are important to healthcare providers and patients with advanced melanoma since they provide a perspective on long-term survival for ipilimumab patients who are alive after three years of treatment. Our data, which represent the longest follow-up of the largest numbers of patients on any globally approved melanoma therapy, will provide a benchmark for future medicines for advanced melanoma."

Ipilimumab is a human monoclonal antibody that activates the immune system to fight melanoma skin cancer by targeting a protein receptor called Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4). In melanoma, CTLA-4 is inhibited from recognising and destroying cancer cells, but ipilimumab turns off the inhibitory mechanism, enabling CTLA-4 to continue killing the cancer cells.

It is already known that some patients treated with the drug survive for long periods, with one phase III clinical trial showing an overall survival rate of 18% after five years. Therefore, Prof Hodi and colleagues from Germany, France and the USA collected data on 1861 patients in 12 prospective and retrospective studies to provide a more precise estimate of ipilimumab's effect on long-term survival. In addition, they analysed data from a further 2985 patients who had been treated with the drug but were not part of any clinical trial, giving the researchers data on a total of 4846 patients.

The analysis of the 1861 patients showed that the median overall survival was 11.4 months (11.4 being the middle number separating the higher half of the patient survival time from the lower half). "Among these patients, 254 patients (22%) were still alive after three years. There were no deaths among patients who survived beyond seven years, at which time the overall survival rate was 17%. The longest overall survival follow-up in the database is 9.9 years," said Prof Hodi.

"The plateau, which started at three years and continued through to ten years, was observed regardless of dose (3 or 10 mg/kg), whether the patients had received previous treatment or not, and whether or not they had been kept on a maintenance dose of the drug. However, as this was not a randomised comparison, one cannot draw direct conclusions on differences between the doses or the populations."

When data from the total 4846 patients were analysed, the median overall survival was 9.5 months, with a plateau in overall survival starting around three years for 21% of the patients. "This slightly lower survival rate was because there were limited and incomplete data on overall survival, and patients given ipilimumab through the extended access programme tended to be more ill and with more advanced disease," explained Prof Hodi.

He concluded: "The limitation of this study is that it is a pooled analysis from phase II, phase III and observational data and not from a single randomised, controlled study. However, these results are consistent with our findings from randomised clinical trials and confirm the durability of the plateau in overall survival, previously shown to extend to at least five years but now shown to extend up to ten years."

Past President of ECCO, Professor Alexander Eggermont, Directeur General of the Institut Gustave Roussy Comprehensive Cancer Center (France), who specialises in the treatment of melanoma, commented: "This pooled analysis clearly demonstrates that ipilimumab can lead to long-lasting tumour control in metastatic melanoma patients. With a response rate of only 10-15%, one can achieve more than 3-10 years survival in 17-25% of patients who have received only a few doses of ipilimumab. Thus, patients apparently can keep residual tumours under control for a long time when the immune system is properly 'reset', and the concept of 'clinical cures' becomes a reality. These survival results could even double or triple with anti-PD1/PDL1 monoclonal antibodies, and metastatic melanoma could become a curable disease for perhaps more than 50% of patients over the coming 5-10 years."

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Longest follow-up of melanoma patients treated with ipilimumab shows some survive up to ten years

Sep. 27, 2013 — Patients with advanced melanoma, who have been treated with the monoclonal antibody, ipilimumab, can survive for up to ten years, according to the largest analysis of overall survival for these patients, presented at the 2013 European Cancer Congress (ECC2013).

Professor Stephen Hodi (MD), Assistant Professor of Medicine at the Dana-Farber Cancer Institute (Boston, USA), told the congress: "Our findings demonstrate that there is a plateau in overall survival, which begins around the third year and extends through to the tenth year.

"These results are important to healthcare providers and patients with advanced melanoma since they provide a perspective on long-term survival for ipilimumab patients who are alive after three years of treatment. Our data, which represent the longest follow-up of the largest numbers of patients on any globally approved melanoma therapy, will provide a benchmark for future medicines for advanced melanoma."

Ipilimumab is a human monoclonal antibody that activates the immune system to fight melanoma skin cancer by targeting a protein receptor called Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4). In melanoma, CTLA-4 is inhibited from recognising and destroying cancer cells, but ipilimumab turns off the inhibitory mechanism, enabling CTLA-4 to continue killing the cancer cells.

It is already known that some patients treated with the drug survive for long periods, with one phase III clinical trial showing an overall survival rate of 18% after five years. Therefore, Prof Hodi and colleagues from Germany, France and the USA collected data on 1861 patients in 12 prospective and retrospective studies to provide a more precise estimate of ipilimumab's effect on long-term survival. In addition, they analysed data from a further 2985 patients who had been treated with the drug but were not part of any clinical trial, giving the researchers data on a total of 4846 patients.

The analysis of the 1861 patients showed that the median overall survival was 11.4 months (11.4 being the middle number separating the higher half of the patient survival time from the lower half). "Among these patients, 254 patients (22%) were still alive after three years. There were no deaths among patients who survived beyond seven years, at which time the overall survival rate was 17%. The longest overall survival follow-up in the database is 9.9 years," said Prof Hodi.

"The plateau, which started at three years and continued through to ten years, was observed regardless of dose (3 or 10 mg/kg), whether the patients had received previous treatment or not, and whether or not they had been kept on a maintenance dose of the drug. However, as this was not a randomised comparison, one cannot draw direct conclusions on differences between the doses or the populations."

When data from the total 4846 patients were analysed, the median overall survival was 9.5 months, with a plateau in overall survival starting around three years for 21% of the patients. "This slightly lower survival rate was because there were limited and incomplete data on overall survival, and patients given ipilimumab through the extended access programme tended to be more ill and with more advanced disease," explained Prof Hodi.

He concluded: "The limitation of this study is that it is a pooled analysis from phase II, phase III and observational data and not from a single randomised, controlled study. However, these results are consistent with our findings from randomised clinical trials and confirm the durability of the plateau in overall survival, previously shown to extend to at least five years but now shown to extend up to ten years."

Past President of ECCO, Professor Alexander Eggermont, Directeur General of the Institut Gustave Roussy Comprehensive Cancer Center (France), who specialises in the treatment of melanoma, commented: "This pooled analysis clearly demonstrates that ipilimumab can lead to long-lasting tumour control in metastatic melanoma patients. With a response rate of only 10-15%, one can achieve more than 3-10 years survival in 17-25% of patients who have received only a few doses of ipilimumab. Thus, patients apparently can keep residual tumours under control for a long time when the immune system is properly 'reset', and the concept of 'clinical cures' becomes a reality. These survival results could even double or triple with anti-PD1/PDL1 monoclonal antibodies, and metastatic melanoma could become a curable disease for perhaps more than 50% of patients over the coming 5-10 years."

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Hyperfractionated radiotherapy improves survival in head and neck cancer patients

Sep. 27, 2013 — The use of an intensified form of radiotherapy in patients with locally advanced head and neck cancers can improve overall survival rates compared with standard radiation therapy, according to results from a large study to be presented at the 2013 European Cancer Congress (ECC2013) [1].

A comparison of altered fractionation radiotherapy (AFRT) with standard fractionation radiotherapy (SFRT) in a meta-analysis of more than 11,000 patients showed an eight percent reduction in the risk of death in the AFRT group, as well as a nine percent reduction in the risk of progression or death.

Dr Pierre Blanchard, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, will tell the congress that, although concomitant chemoradiation (CRT), where radiotherapy and chemotherapy are delivered together, remains the standard of care for patients with locally advanced head and neck squamous cell carcinomas, AFRT should be considered when treatment intensification is sought-after and CRT is not feasible because of other pre-existing conditions such as cardiac and renal disease.

AFRT is an intensified radiotherapy treatment that can be given in various schedules. The first is hyperfractionation, where radiotherapy is given twice daily ten times per week, resulting in a higher total dose of around 80 Grays (Gy) [2] compared with the dose of 70 Gy given using SFRT in the same overall time (around seven weeks). The second way uses an accelerated schedule, where the overall treatment time is reduced but the dose is kept at the same level or at a lower dose. AFRT is associated with increased acute side effects but not late side effects, compared to SFRT.

"After than more than seven years patient follow-up, our research has shown that the higher dose intensity of AFRT works to improve outcomes," says Dr Blanchard. "The hyperfractionated regime is the most effective in terms of overall survival. Indeed, in this group of trials the risk of death is reduced by 18% by the use of hyperfractionated RT, with 41% of patients alive at five years compared to 33% in the SFRT group. While the acute side effects of AFRT are increased compared to those experienced by patients on SFRT, the late side effects are comparable and, overall, side effects are more than compensated for by the significant increase in survival in the AFRT group."

The meta-analysis was carried out by an international collaboration known as MARCH, including many countries in Europe, the USA, Canada, and Brazil, Egypt and developing countries through the International Atomic Energy Authority. The researchers say that the survival benefits are mostly related to improvements in loco-regional control, the area located close to the primary tumour being by far the most common first site of relapse in this disease.

"These data are a major advance for the understanding of the role in AFRT in head and neck squamous cell carcinoma," says Dr Blanchard. "By carrying out a large-scale analysis such as this one, we believe that we have provided enough evidence to indicate that doctors should recommend AFRT as a validated treatment option for head and neck cancer patients."

Professor Cornelis van de Velde, President of ECCO, said: "This large-scale analysis of patients with head and neck cancer shows that hyperfractionation increases survival, and local control is also improved by the use of this technique. This is an important step forward in the treatment of this devastating disease."

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Hyperfractionated radiotherapy improves survival in head and neck cancer patients

Sep. 27, 2013 — The use of an intensified form of radiotherapy in patients with locally advanced head and neck cancers can improve overall survival rates compared with standard radiation therapy, according to results from a large study to be presented at the 2013 European Cancer Congress (ECC2013) [1].

A comparison of altered fractionation radiotherapy (AFRT) with standard fractionation radiotherapy (SFRT) in a meta-analysis of more than 11,000 patients showed an eight percent reduction in the risk of death in the AFRT group, as well as a nine percent reduction in the risk of progression or death.

Dr Pierre Blanchard, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, will tell the congress that, although concomitant chemoradiation (CRT), where radiotherapy and chemotherapy are delivered together, remains the standard of care for patients with locally advanced head and neck squamous cell carcinomas, AFRT should be considered when treatment intensification is sought-after and CRT is not feasible because of other pre-existing conditions such as cardiac and renal disease.

AFRT is an intensified radiotherapy treatment that can be given in various schedules. The first is hyperfractionation, where radiotherapy is given twice daily ten times per week, resulting in a higher total dose of around 80 Grays (Gy) [2] compared with the dose of 70 Gy given using SFRT in the same overall time (around seven weeks). The second way uses an accelerated schedule, where the overall treatment time is reduced but the dose is kept at the same level or at a lower dose. AFRT is associated with increased acute side effects but not late side effects, compared to SFRT.

"After than more than seven years patient follow-up, our research has shown that the higher dose intensity of AFRT works to improve outcomes," says Dr Blanchard. "The hyperfractionated regime is the most effective in terms of overall survival. Indeed, in this group of trials the risk of death is reduced by 18% by the use of hyperfractionated RT, with 41% of patients alive at five years compared to 33% in the SFRT group. While the acute side effects of AFRT are increased compared to those experienced by patients on SFRT, the late side effects are comparable and, overall, side effects are more than compensated for by the significant increase in survival in the AFRT group."

The meta-analysis was carried out by an international collaboration known as MARCH, including many countries in Europe, the USA, Canada, and Brazil, Egypt and developing countries through the International Atomic Energy Authority. The researchers say that the survival benefits are mostly related to improvements in loco-regional control, the area located close to the primary tumour being by far the most common first site of relapse in this disease.

"These data are a major advance for the understanding of the role in AFRT in head and neck squamous cell carcinoma," says Dr Blanchard. "By carrying out a large-scale analysis such as this one, we believe that we have provided enough evidence to indicate that doctors should recommend AFRT as a validated treatment option for head and neck cancer patients."

Professor Cornelis van de Velde, President of ECCO, said: "This large-scale analysis of patients with head and neck cancer shows that hyperfractionation increases survival, and local control is also improved by the use of this technique. This is an important step forward in the treatment of this devastating disease."

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Everolimus slows disease progression in advanced kidney cancer patients

Sep. 27, 2013 — The first Phase II study to investigate the use of the anti-cancer drug, everolimus, for the initial treatment of advanced papillary kidney cancer has shown that it is successful in slowing or preventing the spread of the disease, according to research to be presented at the 2013 European Cancer Congress (ECC2013).

Dr Bernard Escudier, Head of the French Group of Immunotherapy and chairman of the Genitourinary tumour board at the Institut Gustave Roussy in Villejuif, France will say: "Our results showed that for 59% of patients who received everolimus as their first-line treatment, their disease did not get worse and remained stable. These findings are important and indicate that more than half of these cancer patients are getting some kind of benefit from everolimus treatment.

"Advanced papillary kidney cancer is a very difficult cancer to treat, and because there is no standard of care, there is disagreement amongst experts regarding the best treatment option for these patients. Our clinical findings are encouraging and suggest that everolimus may represent a new treatment option."

Papillary kidney cancer is the second most frequent type of kidney cancer and accounts for approximately 15% of all kidney cancer cases; it is five times more common in men than in women. When the cancer is confined to one location, surgical removal is usually associated with an excellent prognosis. However, when it spreads to other parts of the body, therapies are ineffective. There are two types of papillary cancer, based on cell appearance (histology), known as type I and type II. Type I are more common and grow slowly, whereas type II papillary kidney cancers are much more aggressive and have a poor prognosis.

Everolimus is an anti-cancer drug known as an mTOR inhibitor; mTOR stands for "mammalian target of rapamycin" and it is a protein that regulates vital cell growth processes, including cell metabolism, growth and proliferation. Its failure to function correctly is involved in the development of several cancers.

Dr Escudier and his colleagues in France, Germany, Italy, Spain, Poland and the UK recruited 92 patients into the RAPTOR (RAD001 in Advanced Papillary Tumor Program in Europe) study, which started in July 2009. The patients, who had never received systemic treatment, were instructed to take the drug orally, once a day, at a dose of 10 mg for as long as they could tolerate it.

Of the 92 enrolled patients, 83 were included in the intention-to-treat (ITT) analysis and 63 were included in the per-protocol (PP) analysis. An ITT analysis examines the study results based on the treatment to which a group of patients is assigned, rather than the treatment received, and reflects real clinical practice. The PP analysis determines the real biological effect of the new drug as it only includes patients who were compliant with the treatment to which they were assigned, and who also adhered to the clinical study instructions. All of the 92 enrolled patients were included in the safety analysis of the data. Tissue samples were analysed by pathologists in the local hospitals to check whether or not the cancer had spread, and the samples were also checked centrally by an independent, expert group of pathologists.

According to the PP analysis carried out by the local investigators, disease was stable and had not progressed after six months in 59% of patients, while the central review confirmed this in 35% of patients. The local investigators found that the time that elapsed before the cancer spread or worsened (progression-free survival) was 7.8 months, while the central pathology review found it was 3.9 months. At least half of the patients were alive at 20 months.

Dr Escudier will say: "Similar results were seen in the ITT analysis and strongly confirm the overall study findings. According to assessments by the local investigators, progression-free survival was 7.6 months, according to the central review it was 3.7 months, and more than half of the patients were alive at 21 months.

"These results underline the differences that are often observed between local investigator assessment and central review according to the established set of rules used to evaluate anti-cancer drugs.

"As far as we know, this study is unique as it was the first study of an mTOR inhibitor to only include patients with advanced papillary kidney cancer and diagnosis was also confirmed by an independent group of pathologists experienced in the classification of kidney cancer to prevent any tumours being classified incorrectly.

"Everolimus represents another interesting treatment option for advanced papillary kidney cancer patients as it seems to extend their survival and time without the disease progressing."

Adverse side-effects were generally well tolerated. They included weakness, tiredness and anemia; 27% of patients discontinued everolimus due to these side-effects. "The typical patient being treated for advanced papillary kidney cancer is middle-aged, active and still working, and the impact of side-effects may be more important to them," he will say.

"While the results from this Phase II study are encouraging, a Phase III trial would need to be done to fully characterise the efficacy and safety profile of everolimus in this patient population," he will conclude.

President of ECCO, Professor Cornelis van de Velde, commented: "Papillary tumours have been excluded from many of the targeted therapy trials. This study on targeting the mTOR pathway in patients with advanced papillary kidney cancer provides a basis for a Phase III trial and is potentially practice changing. It also emphasises the need for expert pathology, since central review gave markedly different results than local review."

ESMO spokesperson, Professor Manuela Schmidinger, Professor of Medicine in the Department of Oncology at the University of Vienna, Austria, commented: "Treatment strategies for metastatic renal cell cancer (RCC) have dramatically improved within the last few years. However, these achievements have been mostly restricted to patients with clear-cell (cc)-RCC. Patients with non-cc-RCC are usually underrepresented in clinical trials, thus the benefits of novel targeted agents remains unclear in this population. So far, attempts to investigate the impact of new drugs in the non-cc-RCC-population have resulted in inconsistent but mostly modest results. This is also due to the fact that studies included different types of non-cc-RCCs; however, these are tumours of different epithelial origin, with different genetic background and different clinical behaviour. RAPTOR is the first prospective study that investigated the impact of a targeted agent, everolimus, in patients with papillary RCC. In this study, Escudier et al demonstrated that everolimus provides a promising median average overall survival in this patient setting. A strength of this trial in contrast to other non-cc-RCC -studies is that only patients with papillary subtypes I and II were included, rather than all different types of non-cc-RCC."

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Unstable chromosomes linked to less favorable response to radiation therapy and surgery in prostate cancer patients

Sep. 25, 2013 — Detailed evaluation of a prostate cancer tumor biopsy may predict treatment outcomes for image-guided radiation therapy (IGRT) or surgery for prostate cancer, according to research presented today at the American Society for Radiation Oncology's (ASTRO's) 55th Annual Meeting. The study results indicate that patients who have abnormal levels of breaks at common fragile sites (CFSs), sites within the chromosomes that are sensitive to DNA damage, are more likely to have their cancer to return -- treatment failure. These CFS break abnormalities are usually associated with instability of the cell's DNA, a phenomenon that is particularly associated with cancer.

In this study, researchers assessed the outcomes of 280 prostate cancer (Cap) patients, and reviewed the DNA "fingerprints" of each patient's tumor (using the patient's initial diagnostic core biopsy) to determine if gene copy number alterations (CNAs), or breaks in CFSs, were related to a less positive response to treatment. Two groups were analyzed: 126 localized intermediate risk CaP patients who had received image-guided radiation therapy (IGRT) treatments, with a mean dose of 74.6 Gy; and 154 localized intermediate and high risk CaP patients who had undergone radical prostatectomy (RP), which is the surgical removal of the entire prostate gland.

Utilizing an array comparative genomic hybridization (aCGH), DNA from frozen needle biopsies of the RT patients was analyzed for 13 previously characterized CFSs: FRA2G, FRA3B, FRA4F, FRA6E, FRA6F, FRA7E, FRA7G, FRA7H, FRA7I, FRA7K, FRA8C, FRA9E, FRA16D. The effect of having at least one CNA in any CFS was assessed using the Kaplan-Meier method and Cox proportional hazard models.

The data revealed a pattern in which the patients who failed treatment had abnormal levels of CNAs at CFSs. In the IGRT group, CNAs in CFSs occurred frequently, with 80 of the patients (64 percent) having a CNA in one or more CFS locations (median was 1, and the range was 0 -- 10).

Each patient's biochemical relapse-free rate (bRFR) was gauged, because if a patient relapses biochemically, his prostate specific antigen level has risen significantly and this is a reasonable indicator that the cancer has recurred. Thus, a high bRFR is desirable. On univariate analysis, patients with a CNA in at least one CFS showed a decreased 5-year bRFR (64 percent), compared with the bRFR of patients without genetic alteration in CFSs (90 percent; HR = 2.13, 95% CI: 1.17-3.86, p = 0.011). After adjusting for clinical factors in a multivariate model, a CNA in a CFS was determined to be a significant independent predictor of decreased response to radiation therapy and higher incidence of recurring cancer. (HR = 2.94, 95% CI: 1.51-5.75, P = 0.0016).

The results of the 154 patients in the RP group were compiled using the publically available Memorial Sloan-Kettering Cancer Center (MSKCC) aCGH database of patients. CNAs in CFSs were also frequent in the RP group, with 81 patients (53 percent) having a CNA in one or more location (median was 1, and the range was 0 -- 6). These results also correlated to decreased 5-year bRFR rates of 68 percent, compared to 82 percent for RP patients without genetic alterations in CFSs (HR = 1.79). Despite this strong trend, after adjusting for clinical factors in a multivariate model, a CNA in a CFS was not a statistically significant predictor of cancer recurrence (HR = 1.52, 95% CI: 0.77-3.02, P = 0.23).

"We thought that patients who have CFS breaks might be more sensitive to radiation therapy-induced DNA damage," said the lead author of the study, Robert G. Bristow, MD, PhD, a Professor within the radiation oncology and medical biophysics departments at the University of Toronto; and a Clinician-Scientist at the Princess Margaret Cancer Centre in Toronto. "We now think that the CFS breaks are a signal that the cancer cell has acquired numerous genetic changes that lead to more aggressive cancer cells that can spread early and outside the prostate gland. Our data suggest that the patients failing treatment are due to early metastatic (distant spread) disease. If we validate this study in similar, but larger groups of patients, we can develop a test based for CFS breaks; the results would allow us to place patients in one of two categories: those whose tumors do not have CFS breaks and who would likely do well with local treatment alone (e.g. radiotherapy or surgery); and, those patients whose tumors do have CFS breaks and would need a more complex treatment protocol, in addition to RT or surgery, to combat distant spread."

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Does not reduce diarrhoea in patients receiving pelvic radiation therapy is sulfasalazine

Patients receiving pelvic cancer radiation therapy (RT) can experience negative side effects of diarrhea, radiation therapy. To treat inflammation of intestine sulfasalazine to decrease diarrhea and oral tablet pelvic irradiation (Killic 2001) in the 31 had been shown in patients with past trials. Sulfasalazine is, according to the study by researchers of the Mayo medical school and Mayo Clinic does not reduce diarrhea No. 55 annual meeting of American Society of radiation oncology (ASTRO). Research, drug than placebo risk of diarrhea and may be associated with determined.

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Proton therapy is cost effective for patients with pediatric brain tumor treatment.

Research affecting mainly children when healthy organs and tissues, spare the Proton line treatment cost effectiveness, external beam radiation therapy were compared with spinal cord and a standard photon radiation therapy, providing accurate tumor dose Proton, announced that the fast-growing brain tumor treatments in the 55 annual general meeting of the American Society of radiation therapy (Astro Boy) by researchers from the Mount Auburn hospital, according to Harvard Medical School (Dana Farber Cancer Institute component) of is a teaching hospital.

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Limited brain Mets with 50 more young adult cancer patients alone, has improved the survival of Stereotactic radiation therapy.

According to the study published in the 55 annual general meeting of the society for radiation oncology (ASTRO)-American whole brain irradiation (Stereotactic ）, adult brain cancer patients 50 years following when dealing with Stereotactic radiosurgery (SRS), and found that there is improvement in survival rates cannot be used. Young patients (50 years old) was found despite the omission of new brain metastasis localization development of big risk with or without. University of Texas MD Anderson Cancer Center, University of Southern California （ USC Norris Comprehensive Cancer Center home ） from the authors of the study are included.

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Environmental enrichment for traumatic brain injury patients may reduce shrinkage in brain

Sep. 24, 2013 — Greg Noack was 24 when he moved from Ontario to Victoria, B.C. He had just graduated from college and was looking forward to a fresh start.

One early morning in 1996, as he was returning home from his graveyard shift at the hotel, Noack was attacked from behind by a group of men.

He doesn't remember being struck on the head. He does remember waking from a 15-day coma to learn he had suffered a traumatic brain injury (TBI).

Noack, through the care of his health-care team, relearned how to walk, write, and feel particular emotions.

"I was enamoured by what my therapists were able to do for me," said Noack. "I was lucky that I got back most of my function."

Three years post-injury, Noack enrolled in Sault College's Occupational Therapist Assistant/Physical Therapist Assistant Program and graduated with honours.

Shortly after, Noack was hired by the Toronto Rehab Acquired Brain Injury Rehab team as an occupational therapist assistant and later became a rehab therapist.

Most recently, he was seconded to Dr. Robin Green's traumatic brain injury research team.

Dr. Green, Senior Scientist and Neuropsychologist, Toronto Rehab and Canada Research Chair in Traumatic Brain Injury, and her Toronto Rehab team have been studying impediments to brain injury recovery as well as treatments to offset the impediments.

Dr. Green's work suggests that moderate-severe TBI may be a progressive neurological disorder -a whole new way of perceiving the condition.

"What may be occurring after a serious brain injury," said Dr. Green, "is that damaged tissue is leaving healthy areas of the brain disconnected and under stimulated. Over time, healthy areas may deteriorate."

Importantly, they discovered that in people with chronic moderate-severe TBI, environmental enrichment -- increased physical, social and cognitive stimulation -- can offset this deterioration.

Her research paper, entitled "Environmental enrichment may protect against hippocampal atrophy in the chronic stages of traumatic brain injury," was published September 24 in Frontiers in Human Neuroscience.

In their study of 25 patients with moderate-severe TBI, her team found a positive reaction to environmental enrichment.

Those who reported greater amounts of environmental enrichment -- for example, reading, problem solving exercises, puzzles, physical activity, socializing -- at 5 months after their injury showed less shrinkage of the hippocampus (associated with memory functioning) from 5 to 28 months post-injury.

"People with moderate-severe TBI are commonly unable to return to the same level of engagement in their work, school or social lives as before the injury," said Dr. Green. "However, those with greater environmental enrichment may be keeping vulnerable areas stimulated. Environmental enrichment is also known to increase production of neurons in the hippocampus and to promote their integration into existing brain networks."

Based on the findings from their study, Green's team is now engaged in research designed to proactively offset deterioration, which includes the delivery of environmental enrichment to patients. Noack is instrumental in delivering enriched therapy for TBI patients who are enrolled in one of Dr. Green's research studies.

"One thing I loved about this study is that it facilitated greater customization of a patient's care," said Noack. "I could see how my patients benefited from the increased amount of stimulation through extended therapy."

"Although the brains of patients are showing negative changes, patients are still showing recovery of their functioning in spite of it," said Dr. Green. "If we are able to offset the negative brain changes through the treatments we are developing, we may be able to very significantly improve patients' recovery and the quality of their aging with a brain injury."

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Older than the newly diagnosed breast cancer patients between high damage.

Many older with newly diagnosed breast cancer women struggling is going to be affected disproportionately African-Americans through the everyday tasks. They're new research to be published soon survey results case Western Reserve University School of medicine, Cleveland (case Comprehensive Cancer Center home ）, cancer researchers from University hospitals case Medical Center online American Cancer Society peer-reviewed journal is. We can benefit from the research results to improve physical function of many breast cancer patients treated.

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