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Treatment of pediatric average-risk medulloblastoma using craniospinal irradiation less than 2500 cGy and chemotherapy: single center experience in Korea

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World Journal of Pediatrics 2017年第4期13卷 367-373页

作者： Jong Hyung Yoon Kyung Duk Park Hyoung Jin Kang Hyery Kim Ji Won Lee Seung-Ki Kim Kyu-Chang Wang Sung-Hye Park Il Han Kim Hee Young Shin Department of Pediatrics Cancer Research InstituteSeoul National University College of MedicineSeoul Department of Pediatrics Hallym University College of medicineChuncheon Sacred Heart HospitalChuncheonKorea Departments of Neurosurgery Seoul National University College of MedicineSeoul Pathology Seoul National University College of MedicineSeoul Radiation Oncology Seoul National University College of MedicineSeoul

Background:Although craniospinal irradiation (CSI) of 2340 cGy plus tumor booster with chemotherapy have been established as a standard treatment of childhood average-risk (AvR) medulloblastoma (MBL) in Western counties,there are a few recent reports in outcomes ofAvR MBL using this strategy in Korean and other Asian children.We investigated the outcome of the Korean children with AvR MBL who were treated with CSI <2500 cGy and chemotherapy.Methods:Between January 2001 and December 2010,clinical characteristics and outcomes of 42 patients who were diagnosed with AvR MBL postoperatively and treated with radiation including CSI <2500 cGy and chemotherapy in Seoul National University Children's Hospital were analyzed.Results:Their median age was 9 years (range:3-18.8),and 29 were male.Histological subtypes were classic type in 28 patients,nodular/desmoplastic in 7,and large cell/anaplastic (LCA) in 7.All the patients received adjuvant radiotherapy (CSI with median 2340 cGy and booster) and multiagent chemotherapy as the first-fine treatment.With a median follow-up of 54 months,12 patients experienced relapse or progression of the tumor.The 3-and 5-year disease-free survival (DFS) rates were 78.0%±6.5% and 75.0%±6.9%,respectively,and overall survival (OS) rates were 85.3%±5.6% and 76.8%±6.9%,respectively.The LCA subtype was associated with poorer DFS (P=0.023) and OS (P=0.008),compared with non-LCA subtypes.Conclusion:The outcomes of children and adolescents with AvR MBL treated with radiation including CSI <2500 cGy and chemotherapy,are compatible to those in Western countries;however,the LCA subtype has a poor outcome with this strategy.

关键词： average-risk craniospinal irradiation medulloblastoma

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Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists' adherence to National Colorectal Cancer Screening and Surveillance Guidelines

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World Journal of Gastroenterology 2018年第6期24卷 716-724页

作者： Stacy Bartnik Menees H Myra Kim Philip Schoenfeld Division of Gastroenterology University of Michigan Health System Division of Gastroenterology Ann Arbor Veterans’ Administration Hospital Center for Statistical Consultation and Research University of Michigan Department of Biostatistics University of Michigan Division of Gastroenterology John D.Dingell VA Medical Center

AIM To quantify the impact of split-dose regimen on endoscopists' compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps(average-risk individuals > 50 years old with a normal screening colonoscopy and 1-2 small polyps. Data were abstracted from two time periods, pre and post-split-dose bowel preparation institution. Main outcome measurements were recommendation for timing of repeat colonoscopy and bowel preparation quality. Bivariate analysis by χ~2 tests and Student's t-tests were performed to assess differences between the two cohorts. Multivariable logistic regression was used with guideline consistent recommendations as the dependent variables and an indicator for 2011 cohort as the primary predictor. RESULTS Four thousand two hundred and twenty-five patients were included in the study; 47.0%(1987) prior to the institution of split dose bowel preparation, and 53.0%(2238) after the institution of split dose bowel preparation. Overall, 82.2%(n = 3472) of the colonoscopies were compliant with guideline recommendations, with a small but significantly increased compliance rate in year 2011(83.7%) compared to year 2009(80.4%, P = 0.005), corresponding to an unadjusted odds ratio of 1.25(95%CI: 1.07-1.47; P = 0.005). Colonoscopies with either "Adequate" or "Excellent" had increased from 30.6% in year 2009 to 39.6% in year 2011(P average-risk patients with normal colonoscopy or 1-2 small polyps.

关键词： Colorectal cancer screening Bowel preparation Colonoscopy average-risk

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Old vs new: risk factors predicting early onset colorectal cancer

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World Journal of Gastrointestinal Oncology 2019年第11期11卷 1011-1020页

作者： Aslam R Syed Payal Thakkar Zachary D Horne Heitham Abdul-Baki Gursimran Kochhar Katie Farah Shyam Thakkar Division of Gastroenterology Allegheny Health NetworkPittsburghPA 15212United States Allegheny Singer Research Institute Allegheny Health NetworkPittsburghPA 15212United States Division of Radiation Oncology Allegheny Health Network Cancer InstitutePittsburghPA 15212United States

BACKGROUND Colorectal cancer(CRC)is the second leading cause of all cancer related deaths in the United States and Europe.Although the incidence has been decreasing for individuals’≥50,it has been on the rise for individualsrisk factors for early-onset CRC.METHODS A population-based cohort analysis using a national database,Explorys,screened all patients with an active electronic medical record from January 2012 to December 2016 with a diagnosis of CRC.Subgroups were stratified based on age(25–49 years vs≥50 years).Demographics,comorbidities,and symptom profiles were recorded and compared between both age groups.Furthermore,the younger group was also compared with a control group consisting of individuals aged 25-49 years within the same timeframe without a diagnosis of CRC.Twentydata points for CRC related factors were analyzed to identify potential risk factors specific to early-onset CRC.RESULTS A total of 68860 patients were identified with CRC,of which 5710(8.3%)were younger than 50 years old,with 4140(73%)between 40-49 years of age.Multivariable analysis was reported using odds ratio(OR)with 95%CI and demonstrated that several factors were associated with an increased risk of CRC in the early-onset group versus the later-onset group.These factors included:African-American race(OR 1.18,95%CI:1.09-1.27,Prisk of CRC were:male gender(OR 1.34,95%CI:1.27-1.41),P<0.001),Caucasian(OR 1.48,95%CI:1.40-1.57,P<0.001)and African-American race(OR 1.25,95%CI:1.17-1.35,P<0.001),presenting symptoms

关键词： Colorectal cancer Early-onset colorectal cancer Colorectal cancer screening Epidemiology analysis Colorectal neoplasm average-risk screening

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