Concurrent use of aromatase inhibitors and hypofractionated radiation therapy

AIM: To retrospectively assess the acute and long-term toxicity using aromatase inhibitors (AI) therapy concurrently with hypofractionated radiotherapy (HFRT) in breast cancer patients. METHODS: From November 1999 to October 2007, 66 patients were treated with breast HFRT and concurrent AI. In 63 patients (95.5%), HFRT delivered a total dose of 32.5 Gy to the whole breast within 5 wk (five fractions, one fraction per week). Other fractionations were chosen in three patients for the patients' personal convenience. A subsequent boost to the tumor bed was delivered in 35 patients (53.0%). Acute toxicities were scored according to the Common Toxicity Criteria for Adverse Events v3. Late toxicity was defined as any toxicity occurring more than 6 mo after completion of HFRT and was scored according to the Late Effects Normal Tissue Task Force-Subjective, Objective, Management and Analytic scale. RESULTS: At the end of the HFRT course, 19 patients (28.8%) had no irradiation-related toxicity. Acute grade 1-2 epithelitis was observed in 46 patients (69.7%). One grade 3 toxicity (1.5%) was observed. With a median follow-up of 34 mo (range: 12-94 mo), 31 patients (47%) had no toxicity, and 35 patients (53%) presented with grade 1-2 fibrosis. No grade 3 or greater delayed toxicity was observed. CONCLUSION: We found that AI was well tolerated when given concurrently with HFRT. All toxicities were mild to moderate, and no treatment disruption was necessary. Further prospective assessment is warranted.

子宫颈癌筛查中传统子宫颈涂片、单层细胞学及人乳头状瘤病毒DNA检测的横断面研究

目的 比较子宫颈癌筛查中传统子宫颈涂片、单层细胞学,以及人乳头状瘤病毒检测的敏感性、特异性和观察者间的可信性。 设计 对同时进行了此3项检查并有参考标准(阴道镜和组织学)者进行横断面研究。 研究单位 法国的公立大学和私人诊所,本研究完全独立于病例提供者。 研究对象 因先前检出的细胞学异常而进行阴道镜检查的828名妇女和参加常规涂片检查的1757名妇女。 主要结果判定指标 临床读片和最优化解释(为取得一致所进行的双盲读片)。根据诊断异常的不同阈值计算出敏感性、特异性和加权κ值。 结果 根据Bethesda系统,传统子宫颈涂片检查得到的结果更为满意(91％比87％),比单层细胞学更可靠(加权κ值0.70比0.57),其敏感性和特异性更高。这些结果适用于临床读片和最优化解释,区分高级别和低级别病变,以及有低和高异常发生率的人群。人乳头状瘤病毒检测与单层细胞学检查同时进行,不论是系统性的还是只对于意义不明的非典型细胞,并不比传统涂片检查优越。 结论 在子宫颈癌筛选中,单层细胞学检查不如传统子宫颈涂片检查可靠,且更容易出现假阳性和假阴性结果。