Does the addition of radiation improve survival compared to chemotherapy alone in women with stage IV endometrial carcinoma? Analysis of the NCDB and SEER databases

OBJECTIVE

To evaluate whether the addition of radiation to adjuvant chemotherapy is associated with improved survival in women with stage IV endometrial cancer following surgery.

METHODS

The National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registries were queried for patients with stage IV endometrial cancer from 2004 to 2017. Treatment was categorized as chemotherapy alone, chemotherapy with external beam radiation therapy (EBRT), chemotherapy with vaginal brachytherapy (VBT), or chemotherapy with EBRT+VBT. Multivariable Cox regression models assessed associations between treatment modality and overall survival (OS).

RESULTS

This analysis included 17,890 (NCDB: 12,812, SEER: 5078) women with stage IV endometrial cancer, including 1757 (9.8%) with IVA disease and 16,133 (90.2%) with IVB. The majority of stage IV patients received chemotherapy alone (NCDB 78.8%, SEER 77.0%). When radiation was utilized in addition to chemotherapy, EBRT was most common (NCDB 15.8%, SEER: 15.4%). In both databases, use of any radiation in addition to chemotherapy was associated with improved OS. Stage IV patients treated with chemotherapy plus EBRT had better survival than those receiving chemotherapy alone [NCDB: HR 0.75 (95% CI 0.70, 0.79), SEER: HR 0.85 (95% CI 0.77, 0.94)]. This benefit was more pronounced in patients with IVA disease [NCDB: HR 0.66 (95% CI 0.55, 0.79), SEER: HR 0.63 (95% CI 0.46, 0.85)]. In histology-stratified analyses, the addition of radiation to chemotherapy was associated with improved OS in all histologies, except clear cell.

CONCLUSIONS

In this analysis of the NCDB and SEER registries, the use of multimodality treatment with radiation and chemotherapy was associated with improved OS compared to chemotherapy alone in women with stage IVA and IVB endometrial cancer.

Deep-Focus Earthquakes and Recycling of Water into the Earth's Mantle

For more than 50 years, observations of earthquakes to depths of 100 to 650 kilometers inside Earth have been enigmatic: at these depths, rocks are expected to deform by ductile flow rather than brittle fracturing or frictional sliding on fault surfaces. Laboratory experiments and detailed calculations of the pressures and temperatures in seismically active subduction zones indicate that this deep-focus seismicity could originate from dehydration and high-pressure structural instabilities occurring in the hydrated part of the lithosphere that sinks into the upper mantle. Thus, seismologists may be mapping the recirculation of water from the oceans back into the deep interior of our planet.

Differential changes in striatal projection neurons in R6/2 transgenic mice for Huntington's disease

In early adult-onset Huntington's disease (HD), enkephalinergic striatopallidal projection neurons show preferential loss, reduced preproenkephalin (PPE) expression in surviving striatopallidal neurons, and loss of fibers in their projection target area. We examined PPE and PPT (preprotachykinin) gene expression in striatal projection neurons and in striatal projection fibers immunoreactive for the PPE product enkephalin (ENK) and the PPT product substance P (SP) in a transgenic HD model, the R6/2 mouse, to see if changes occur in these neuron types similar to those seen in early adult-onset HD. The results show that PPE mRNA level, the number of striatal neurons expressing PPE, and the staining intensity of fibers immunoreactive for ENK in the pallidum were all decreased. By contrast, the SP-containing striatal projection systems to the pallidum and substantia nigra were relatively normal in R6/2 mice. The selective reduction in striatal PPE in R6/2 mice is reminiscent of adult-onset HD, but the preservation of the striatonigral projection system is not. Thus, R6/2 mice do not strictly mimic adult-onset HD in their striatal pathology.

Comparing first and subsequent suprapubic catheter change: complications and costs

Urologic and continence nursing advanced significantly during the 1990s. Today's health care environment emphasizes careful rationalizing of hospital-based resources. This trend is more or less responsible for the demise of medically managed suprapubic catheter (SPC) change. The results of this study indicate that first change of SPC, performed in the patient's home or outpatient clinic by appropriately skilled registered nurses, is a cost-effective practice with no increased risk of complication to the patient.

Enhanced decision-making: the use of a videotape decision-aid for patients with prostate cancer

We describe the development and evaluation of a videotape decision-aid to assist patients in considering treatment options for clinically localized prostate cancer. The content and form of the videotape were developed utilizing literature review, an expert opinion panel and patient focus groups. Thirty-two men, aged 50-85 years, who did not have prostate cancer underwent pre- and post-videotape testing. A quantitative analysis found the videotape to be moderately effective in improving short-term recall of treatment options and outcomes. Qualitative analysis demonstrate that after viewing the videotape, subjects were more likely to consider an active role in the treatment decision-making process. We conclude that a videotape decision-aid will benefit clinical practice by conveying knowledge to patients regarding treatment options and outcomes and encouraging them to participate with their physicians in medical decision-making.

High-Temperature Phase Transition and Dissociation of (Mg, Fe)SiO 3 Perovskite at Lower Mantle Pressures

To study the crystallography of Earth's lower mantle, techniques for measuring synchrotron x-ray diffraction from a laser-heated diamond anvil cell have been developed. Experiments on samples of (Mg, Fe)SiO(3) show that silicate perovskite maintains its orthorhombic symmetry at 38 gigapascals and 1850 kelvin. Measurements at 65 and 70 gigapascals provide evidence for a temperature-induced orthorhombic-to-cubic phase transition and dissociation to an assemblage of perovskite and mixed oxides. If these phase transitions occur in Earth, they will require a significant change in mineralogical models of the lower mantle.

Rupture Characteristics of the Deep Bolivian Earthquake of 9 June 1994 and the Mechanism of Deep-Focus Earthquakes

The M(w) = 8.3 deep (636 kilometers) Bolivian earthquake of 9 June 1994 was the largest deep-focus earthquake ever recorded. Seismic data from permanent stations plus portable instruments in South America show that rupture occurred on a horizontal plane and extended at least 30 by 50 kilometers. Rupture proceeded at 1 to 3 kilometers per second along the down-dip azimuth of the slab and penetrated through more than a third of the slab thickness. This extent is more than three times that expected for a metastable wedge of olivine at the core of the slab, and thus appears to be incompatible with an origin by transformational faulting. These large events may instead represent slip on preserved zones of weakness established in oceanic lithosphere at the Earth's surface.

Synchrotron Infrared Absorbance Measurements of Hydrogen in MgSiO 3 Perovskite

Micro-infrared spectroscopic measurements on single crystals of MgSiO(3) perovskite document two pleochroic hydroxyl absorbance peaks at 3483 and 3423 centimeter(-1). These measurements were obtained with the use of a synchrotron infrared source for spectroscopy. These data are consistent with a trace hydrogen content of 700 +/- 170 hydrogen atoms per 10(6) silicon atoms in the nominally anhydrous MgSiO(3) perovskite. When integrated over the volume of the lower mantle, this concentration is comparable to 12 percent of the mass of hydrogen in the Earth's hydrosphere.

Ultrahigh-Pressure Melting of Lead: A Multidisciplinary Study

Measurements of the melting temperature of lead, carried out to pressures of 1 megabar (10(11) pascal) and temperatures near 4000 kelvin by means of a laser-heated diamond cell, are in excellent agreement with the results of previous shock-wave experiments. The data are analyzed by means of first principles quantum mechanical calculations, and the agreement documents the reliability of current experimental and theoretical techniques for studies of melting at ultrahigh pressures. These studies have potentially wide-ranging applications, from planetary science to condensed matter physics.

Effect of a Coordination Change on the Strength of Amorphous SiO 2

Measurements of the yield strength of SiO(2) glass to pressures as high as 81 gigapascals at room temperature show that the strength of amorphous silica decreases significantly as it is compressed to denser strctures with higher coordination. Above 27 gigapascals, as the silicon in amorphous SiO(2) is continuously transformed from fourfold to sixfold coordination, the strength of the glass decrases by more than an order of magnitude. These data confirm theoretical predictions that the mechanical properties of polymerized amorphous silicates are sensitive to pressure-induced structural transformations and suggest that the viscosity of silica-rich liquids decreases significantly at high pressures. Such a change in melt rheology could enhance the processes of chemical differentiation with depth in the Earth's mantle.

Differential application of cue-controlled relaxation in the reduction of general anxiety

This exploratory study investigated the effectiveness of cue-controlled relaxation in the multiple-outcome reduction of general anxiety. Additionally, it examined the effects of matching the technique's presentation with trainee conceptual level. Results suggested that the technique significantly reduced general anxiety. Multivariate analysis of covariance also indicated that the training was differentially effective relative to trainee conceptual level, but not relative to the type of technique presentation.

Isolation of an endogenous type C virus related to the infectious primate type C viruses from the Asian rodent Vandeleuria oleracea

A tissue culture line derived from the Asian rodent Vandeleuria oleracea has been shown to release an infectious, xenotropic type C virus. The virus-associated reverse transcriptase (RNA-dependent DNA nucleotidyltransferase) and the major internal protein p30 are immunologically related to the respective proteins of the woolly monkey-gibbon ape group of infectious primate viruses. By these criteria the V. oleracea viral isolate is similar to the murine type C-I class of endogenous retroviruses and has been designated Vand C-I. Nucleic acid homology studies show that V. oleracea cellular DNA shares similar levels of homology with DNA from members of the Mus and Rattus genera and lower levels of homology with other rodent genera. The Vand C-I viral genome is present in V. oleracea cellular DNA in multiple copies, and partially related sequences can be detected in other rodent genera. These results support the conclusion that the Vand C-I viral genome is genetically transmitted in V. oleracea and that the type C-I class of endogenous retroviral genes has been highly conserved during evolution.