Children being given unnecessary chest X-rays

Researchers at Mayo Clinic found that some children are receiving chest X-rays that may be unnecessary and offer no clinical benefit to the patient, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“Chest X-rays can be a valuable exam when ordered for the correct indications,” said Ann Packard, M.D., radiologist at the Mayo Clinic in Rochester, Minn. “However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost.”

Dr. Packard and co-author, Kristen B. Thomas, M.D., head of the pediatric division at Mayo Clinic and assistant professor of radiology at Mayo Medical School, reviewed data from 719 pediatric chest X-ray exams ordered between 2008 and 2014 in Mayo Clinic’s inpatient, outpatient and emergency room settings. The patients undergoing the exams ranged in age from newborn to 17 years old.

Of the 719 X-ray exams, 377 exams were ordered for chest pain, 98 indicated syncope (fainting) or presyncope, 21 indicated spells (a general feeling of being unwell or under distress), 37 indicated postural orthostatic hypotension (POTS)–a condition in whichblood pressure drops suddenly when the individual stands up from sitting or lying down, 185 indicated dizziness, and one exam indicated cyclical vomiting. Eighty-two of the 719 exams were excluded due to congenital or other known heart disease, and other causes.

The researchers found that in approximately 88 percent of the remaining 637 patients, the exam did not alter clinical treatment.

None of the patients who underwent X-rays for indications including syncope, spells, POTS, dizziness or cyclical vomiting had any finding that affected treatment. Thirty-nine of the 330 non-excluded X-rays for chest pain were positive for pneumonia, bronchial inflammation, trauma, or other conditions.

“Approximately 12 percent of the chest X-rays for chest pain were positive and included respiratory symptoms such as cough, fever or trauma,” Dr. Packard said. “There were no positive findings in any chest X-ray for syncope, dizziness, spells, cyclical vomiting or POTS for the past five years, even in our tertiary care center with referrals for rare diseases or unusual presentations.”

Optimizing radiation exposure and cost effectiveness are important topics in today’s healthcare environment, particularly in a pediatric population, Dr. Packard noted.

“This study addresses both of these issues, which is important not only for physicians but also for young patients and their parents,” she said. “I would like this research to help guide clinicians and deter them from ordering unnecessary exams which offer no clinical benefit to the patient.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/286442.php

 

 

Surgery plus chemoradiation linked to improved survival rates for gastric cancer patients

Patients who receive chemotherapy and radiation after surgery for gastric cancer appear to have better survival rates than those who had surgery followed by only chemotherapy, according to results of a look-back study of more than 500 people by Johns Hopkins scientists.

The combination of post-operative chemotherapy and radiation, or chemoradiation, resulted in survival for an average of 46.7 months after treatment, compared to 20.9 months among those who received chemotherapy only after surgery. Five years after treatment, 46.9 percent of chemoradiation-plus-surgery patients were still living, while 24.9 percent of chemotherapy-plus-surgery patients survived.

Chemoradiation also improved patients’ recurrence-free survival, to an average of 35.6 months, compared with 16.6 months among those who received chemotherapy alone.

The addition of radiation especially improved survival rates among gastric cancer patients whose cancers had spread to lymph nodes in the immediate region of the stomach, says Timothy Pawlik, M.D., M.P.H., Ph.D., professor of surgery at the Johns Hopkins University School of Medicine and member of the Johns Hopkins Kimmel Cancer Center.

Pawlik says the role of radiation therapy in treating gastric cancer has been understudied, “but these data would suggest that radiation therapy would benefit patients, in particular those patients who had disease that has spread to lymph nodes.”

Although rates of gastric cancer have dropped in recent years in the United States, it is still the fourth most common cancer and the second-leading cause of cancer deaths worldwide.

The study results, described in the Annals of Surgical Oncology, is a so-called retrospective one, looking at the records of 505 gastric cancer patients treated between 2000 and 2012. Retrospective studies come with a certain amount of limitation and bias, Pawlik says, because researchers can only analyze how therapy was carried out and can’t control which patients received which treatments.

Pawlik and his colleagues attempted to remove some of that bias in their study with a statistical fix. Using information on the patients’ ages, tumor sizes and other factors collected from the multi-institutional U.S. Gastric Cancer Collaborative database, the researchers were able to build a score that measured how likely it would be for a patient to receive chemoradiation along with surgery. Within groups of patients with similar scores, they were able to compare the outcomes between those who did get chemoradiation and those who had chemotherapy only.

This “fancy matching” helps get rid of some but not all of the bias in a retrospective study, says Pawlik. “It is possible that patients who got radiation therapy were younger, healthier, and could more easily tolerate radiation therapy, which factored into longer survival.”

Chemoradiation therapy also has improved over the past decade, making it an important tool to consider when treating gastric cancer, says Joseph Herman, M.D., director of clinical research in the Department of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins. “Some patients will benefit more from chemoradiation, and these large studies can give us more insight into who these patients might be.”

Other researchers involved in the study include Aslam Ejaz, Gaya Spolverato and Yuhree Kim of the Johns Hopkins University School of Medicine; Malcolm H. Squires and Shishir K. Maithel of Emory University; George Poultsides and David J. Worhunskyof Stanford University; Ryan Fields and Linda X. Jin of Washington University in St. Louis; Mark Bloomston, Carl Schmidt and Neil Saunders of The Ohio State University; Sharon M. Weber, Alexandra W. Acher and Clifford S. Cho of the University of Wisconsin; and Konstantinos Votanopoulos and Douglas Swords of Wake Forest University.

Ejaz was supported in part by the Eleanor B. Pillsbury Foundation for Surgical Research

 

 

Interstitial lung disease is a significant risk factor for lung inflammation following stereotactic body radiation therapy for lung cancer

Pretreatment interstitial lung disease (ILD) is a significant risk factor for developing symptomatic and severe radiation pneumonitis in stage I non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT) alone.

ILD is a group of diseases that cause scarring and stiffing of the tissue and space around the air sacs in the lungs, which results in diminished gas exchange. The incidence of ILD among lung cancer patients is higher than in the general population as tobacco smoking is a common risk factor for both. Some lung cancer patients with ILD may not be considered good candidates for surgical therapy. SBRT uses sophisticated techniques to deliver a targeted and focused radiation dose to a tumor in order to stop the growth locally with limited damage to surrounding healthy tissue. SBRT is considered an acceptable therapy choice for early-stage NSCLC patients who are not good candidates for or decline surgery.

In order to determine the optimal treatment for early-stage lung cancer patients with ILD, researchers at Kyoto University in Japan examined the incidence of radiation pneumonitis and the clinical outcomes in 157 patients who underwent SBRT alone for stage I NSCLC.

Results published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), show that of the 157 patients who received SBRT for lung cancer therapy, 20 were identified as having pretreatment ILD. The presence of ILD was a significant risk factor for both symptomatic and severe radiation pneumonitis and the cumulative incidence of radiation pneumonitis increased significantly with worse ILD. Overall survival trended to be shorter in the ILD positive population but this was not statistically significant and may be accountable to the ILD itself. There were no differences in disease progression or local progression rates in patients with ILD versus those patients without.

“Our results suggest that the impact of ILD on radiation pneumonitis depends on the preexisting severity of the ILD findings and clinicians should be cautious when considering SBRT for those with significant ILD findings”, say the authors. “However, other than radiation pneumonitis, life-threatening complications after SBRT are rare. Thus, if the severity of ILD and the risk of radiation pneumonitis are carefully evaluated, SBRT is a curative-intent treatment option for those with early-stage NSCLC and pretreatment ILD.”

http://www.medicalnewstoday.com/releases/285268.php

 

Picture courtesy of www.nature.com

 

Health costs could be reduced by more appropriate use of cardiac stress testing with imaging

In a new study recently published in the Annals of Internal Medicine, researchers at NYU Langone Medical Center concluded that overuse of cardiac stress testing with imaging has led to rising healthcare costs and unnecessary radiation exposure to patients.

In what is believed to be the first comprehensive examination of trends in cardiac stress testing utilizing imaging, researchers also showed that there are no significant racial or ethnic health disparities in its use. They also made national estimates of the cost of unnecessary cardiac stress testing with imaging and the health burden of this testing, in terms of cancer risk due to radiation exposure.

Cardiac stress testing, particularly with imaging, has been the focus of debate about rising health care costs, inappropriate use, and patient safety in the context of radiation exposure. Joseph Ladapo, MD, PhD, assistant professor in the Departments of Medicine and Population Health at NYU Langone, and the lead author of the study, and colleagues wanted to determine whether U.S. trends in cardiac stress testing with imaging may be attributable to population shifts in demographics, risk factors, and provider characteristics, and to evaluate whether racial/ethnic disparities exist in physician decision making.

They designed their study utilizing data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 to 2010. Patients chosen for the study were adults without coronary heart disease who were referred for cardiac stress tests.

Between 1993 to 1995 and 2008 to 2010, the annual number of ambulatory visits in the U.S. in which a cardiac stresstest was ordered or performed increased by more than 50%. Cardiac stress tests with imaging comprised a growing portion of all of these tests – increasing from 59% in 1993 to 1995 to 87% in 2008 to 2010. At least 34.6% – or one million tests – were probably inappropriate, the researchers concluded, with associated annual costs and harms of $501 million and 491 future cases of cancer.

The authors also concluded that there was no evidence of a lower likelihood of black patients receiving a cardiac stresstest with imaging (odds ratio, 0.91 [95% CI, 0.69 to 1.21]) than their white counterparts – although some modest evidence of disparity in Hispanic patients was found (odds ratio, 0.75 [CI, 0.55 to 1.02]).

The investigators concluded that the national growth in cardiac stress testing can be attributed largely to population and provider characteristics – but the use of imaging cannot. Physician decision making about cardiac stress testing also does not result in racial/ethnic disparities in cardiovascular disease.

“Cardiac stress testing is an important clinical tool,” says Dr. Ladapo, “but we are over using imaging for reasons unrelated to clinical need. This is causing preventable harm and increasing healthcare costs.

“Reducing unnecessary testing also will concomitantly reduce the incidence of radiation related cancer,” he adds. “We estimate that about 500 people get cancer each year in the US from radiation received during a cardiac stress test when, in fact, they most probably didn’t need any radiological imaging in the first place. While this number might seem relatively small, we must remember that ‘first, do no harm’ is one of the guiding principles in medicine.”

So what can be done to reduce unnecessary cardiac stress testing with imaging? “More efforts, such as clinical decision support, are needed to reduce unnecessary cardiac stress testing,” Dr. Ladapo concludes, suggesting greater use ofstress testing without radiological imaging, such as regular exercise treadmill tests or stress testing with ultrasoundimaging as opposed to CT imaging.

As to the reason why certain racial and ethnic minorities have poorer rates of treatment for cardiovascular disease and generally have poorer cardiovascular health outcomes compared to white patients, Dr. Ladapo concludes that no one has really explored whether there could be disparities in cardiac stress testing, which is a mainstay of diagnosing patients with heart disease in this country. “If we know that one minority group has a higher incidence of poorer outcomes from heart disease, perhaps we need to examine if they would benefit from more appropriate use of cardiac stress testing,” he offers. “Perhaps one contributing reason they have poorer outcomes is because we are not testing them appropriately.”

http://www.medicalnewstoday.com/releases/283694.php

 

Exercise can enhance tumor-shrinking effects of chemotherapy

New research published in the American Journal of Physiology, suggests exercise may boost the tumor-shrinking effects of chemotherapy.

In a study of mice with melanoma, scientists from the University of Pennsylvania (Penn) in Philadelphia, found that chemotherapy shrank more tumors when combined with exercise.

Senior author Joseph Libonati, an associate professor in Penn’s School of Nursing, and colleagues were originally trying to find out if exercise could protectcancer patients against the heart damage that can result from use of the common cancer drug doxorubicin.

Although the drug is effective against a variety of cancers, one of its side effects is the potential damage it can do to heart cells. In the long term, this can causeheart failure.

Prof. Libonati says at first, all cancer patients are concerned about is the cancer, “and they’ll do whatever it takes to get rid of it.”

“But then when you get over that hump you have to deal with the long-term elevated risk of cardiovascular disease,” he adds.

There is evidence that taking up regular exercise before undergoing chemotherapy can protect heart cells from the damaging effects of doxorubicin. But not many have investigated whether there is any benefit from exercising during chemotherapy.

For their study, the team picked four groups of mice and induced them with melanoma. Over the next 2 weeks, two of the groups received two injections of doxorubicin, and two received placebo injections.

At the same time, mice in one of the chemotherapy groups and one of the placebo groups were placed on exercise regimens. The other mice did not exercise during the treatment period. The exercising mice walked on treadmills for 45 minutes a day on 5 days of each week.

Exercise helped chemotherapy shrink tumors but did not change effect on heart

After the 2-week period, the team found the mice that received chemotherapy – regardless of whether they had exercised or not – showed signs of heart damage. The damage consisted of reduced heart function and increased fibrosis or tissue thickening.

As Prof. Libonati says, “exercise didn’t do anything to the heart – it didn’t worsen it, it didn’t help it.”

But he and his team were amazed when they looked at the tumors. They found the mice that had received chemotherapy and exercised had much smaller tumors after 2 weeks than the sedentary mice on chemotherapy.

They conclude that in mice with melanoma, exercise appears to boost the tumor-shrinking effects of doxorubicin, without having an effect on the damage the drug can do to the heart.

They suggest further studies should now look into exactly how exercise boosts the effects of chemotherapy. Perhaps a reason is because exercise improves blood flow, which allows more of the drug to reach the cancer cells.

Prof. Libonati adds, “If exercise helps in this way, you could potentially use a smaller dose of the drug and get fewer side effects.”

He explains that we are only just beginning to understand the effect exercise can have on drug- taking:

“People don’t take a drug and then sit down all day. Something as simple as moving affects how drugs are metabolized.”

Finding out more about how exercise affects the body could lead to drugs that mimic the effects of exercise.

Funds for the study came from the National Cancer Institute, the National Heart Lung and Blood Institute, the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the Biobehavioral Research Center at Penn.

Meanwhile, Medical News Today recently learned of a study published in Science Translational Medicine that showed how tumors shrank following a bacteria injection. The researchers shrank cancer tumors in rats, dogs and also one human patient, by directly injecting the tumors with a modified version of Clostridium novyi to trigger targeted anti-cancer responses.

Written by Catharine Paddock PhD

Copyright: Medical News Today

http://www.medicalnewstoday.com/articles/282767.php

 

 

UCLA scientists unlock protein that can accelerate recovery in cancer patients following radiation and chemotherapy

Scientists from UCLA’s Jonsson Comprehensive Cancer Center (JCCC) have shown for the first time how a unique protein found in human bone marrow can drive stem cells to repair our blood system after an injury. These groundbreaking findings provide a roadmap to make existing radiation and chemotherapy treatments more effective for patients with cancer and other blood-related diseases.

Led by Dr. John Chute, UCLA professor of hematology and radiation oncology and JCCC member, the nearly two-year study was published online ahead of print in the Journal of Clinical Investigation.

Millions of cancer patients worldwide currently receive some form of radiation therapy or chemotherapy in hopes of curing the disease, and most will suffer damage to the blood system as a result. Current therapeutic regimens are also cyclical (generally requiring a 30-day wait period between treatments) to allow the blood system time to heal and repair.

Hematopoietic stem cells (HSCs) are cells in our body that can change and become any other type of blood cell (such as red or white blood cells). Scientists have long used HSCs in the laboratory to study how the bone marrow in our body can regulate and instruct these blood stem cells to regenerate and repair themselves, and thus help our bodies to recover after an injury or stress (such as following radiation or chemotherapy).

In his prior research, Dr. Chute discovered that specific cells that make up the lining of blood vessels in our bone marrow (called endothelial cells) play a key role in telling HSCs how to renew and repair themselves. He further theorized that following an injury or stress to our body, the blood system as a whole will benefit as the activities and functions happening in our bone marrow directly drive HSCs to promote and accelerate recovery.

In this new study, Dr. Chute and colleagues built upon their research to specifically identify a new protein called pleiotrophin. They discovered that the protein binds to HSCs, and that it is this process that activates recovery of blood stem cells and our entire blood system.

Dr. Chute’s team conducted experiments in mouse models to administer pleiotrophin after a normally lethal dose of radiation. Results showed that HSCs and the blood system recovered faster, and in two thirds of the cases the animal survived.

Additionally, Dr. Chute’s team found in further testing that by doing the opposite and actually blocking pleiotrophin (thereby preventing it from functioning), the blood stem cells saw no advantage in recovery. This highly suggests that the protein is key in accelerating recovery of the blood system.

“We have now discovered the mechanism by which pleiotrophin can instruct blood stem cells to regenerate,” said Dr. Chute. “By modeling it for potential use in human patients, this opens the door for tremendous therapeutic possibilities.”

Dr. Chute and his team are currently pursuing a Phase I clinical trial, with the goal of accelerated recovery for patients undergoing all types of radiation and chemotherapy as well as lessened delays between treatments.

“With this discovery, we hope to provide the basis for improving outcomes for patients with cancer or other blood-related diseases and who are undergoing highly toxic treatments,” said Dr. Chute.

This research was supported by funding from the National Institute of Allergy and Infectious Diseases and National Heart, Lung, and Blood Institute. Additional funding was provided by the UCLA Broad Stem Cell Research Center.

http://www.medicalnewstoday.com/releases/283036.php

 

 

Combined therapy improves survival for patients with liver cancer who are not suitable for surgery

The mature results from a trial conducted by the Asia-Pacific Hepatocellular Carcinoma Trials Group led by the National Cancer Centre Singapore (NCCS) and Singapore General Hospital (SGH) have shown that patients who suffer from inoperable advanced hepatocellular carcinoma (HCC) may have a chance to live significantly longer by using a combined therapy.

The multi-centre phase II clinical trial was conducted at four Asia Pacific tertiary medical centres to evaluate the efficacy of combining two existing treatment modalities, Sorafenib and Selective Internal Radiation Therapy (SIRT). The combination therapy involves starting patients on SIRT using SIR-Spheres microspheres, a medical device that contains radioactive microspheres labeled with yttrium-90 for short range high energy radiation therapy, followed by systemic therapy with an oral chemotherapy drug, Sorafenib, 14 days later.

The mature results of the trial published recently in a peer-reviewed journal, PLOS ONE, show that median overall survival was 20.3 months for patients with intermediate stage HCC and 8.6 months for patients with advanced liver cancer. These final results were better than the preliminary data released in 2010.

Led by Prof Pierce Chow, Senior Consultant Surgeon at NCCS and SGH, the investigator-initiated trial, which commenced in June 2008, recruited 29 patients from four countries namely Malaysia, Myanmar, Singapore and South Korea.

“Hepatocellular carcinoma is the most common type of liver cancer with limited treatment options. About 1 million individuals are diagnosed with the condition annually and only 20 per cent of them are eligible for potentially curative treatment. This is a major concern and we aim to change that,” said Prof Chow.

“It is through collaboration with hospitals and medical centres in the region that we can further our understanding of this disease that is so prevalent in the Asian population. This multi-centre phase II clinical trial, which showed that the combination therapy improves survival, is an example of how patients can benefit from the collaboration.”

The trial also revealed that median time to progression was 15.2 months and 9 months for patients with locally advanced HCC and patients with metastatic liver cancer respectively. This means that patients are able to enjoy better quality of life for a longer period, from the time therapy starts till the disease progresses.

The results of the trial also compare favorably with the known outcomes of current monotherapy treatments such as the overall survival following transarterial embolization in Asia-Pacific patients with intermediate or advanced HCC (median 18.2 and 6.8 months, respectively).

“This is an improvement of the initial result in 2010, which were already better than treatment with either therapy alone. It is very encouraging as it justifies our perseverance in seeking a deeper understanding of how we can treat this form of cancer to achieve the best results for our patient, ” said Prof Soo Khee Chee, Director of NCCS who is also involved in the Phase II study.

The trial also demonstrated that patients with locally advanced HCC can also be downstaged to receive potentially curative treatment. In the trial two patients were downstaged to receive radio-frequency ablation. Outside of this phase II trial, four other clinical patients became amendable to surgery after treatment with SIRT and another became amendable to liver transplantation after receiving combination SIRT and sorafenib therapy. Potentially curative treatment such as surgical resection, transplantation and radiofrequency ablation are otherwise not options for patients with advanced HCC. If left untreated, they have a median survival of about 4 to 8 months.

HCC, a form of liver cancer, is the 5th most common cancer worldwide. Almost 80 per cent of HCC cases are found in the Asia-Pacific region. As the majority of patients with liver cancer do not develop any symptoms, only one in five of them can potentially be cured by surgery when diagnosed.

In view of the success of the phase II trial, the phase III multi-centre trial has commenced to determine if SIRT would help patients survive longer and would potentially be the first line therapy for advanced HCC.

http://www.medicalnewstoday.com/releases/282225.php

 

 

Nanoparticles used to enhance chemotherapy

University of Georgia researchers have developed a new formulation of cisplatin, a common chemotherapydrug, that significantly increases the drug’s ability to target and destroy cancerous cells.

Cisplatin may be used to treat a variety of cancers, but it is most commonly prescribed for cancer of the bladder, ovaries, cervix, testicles and lung. It is an effective drug, but many cancerous cells develop resistance to the treatment.

Shanta Dhar, assistant professor of chemistry in the UGA Franklin College of Arts and Sciences, and Rakesh Pathak, a postdoctoral researcher in Dhar’s lab, constructed a modified version of cisplatin called Platin-M, which is designed to overcome this resistance by attacking mitochondria within cancerous cells. They published their findings recently in the Proceedings of the National Academy of Sciences.

“You can think of mitochondria as a kind of powerhouse for the cell, generating the energy it needs to grow and reproduce,” said Dhar, a member of the UGA Cancer Center and principal investigator for the project. “This prodrug delivers cisplatin directly to the mitochondria in cancerous cells. Without that essential powerhouse, the cell cannot survive.”

Sean Marrache, a graduate student in Dhar’s lab, entrapped Platin-M in a specially designed nanoparticle 1,000 times finer than a human hair that seeks out the mitochondria and releases the drug. Once inside, Platin-M interferes with the mitochondria’s DNA, triggering cell death.

Dhar’s research team tested Platin-M on neuroblastoma – a cancer commonly diagnosed in children-that typically originates in the adrenal glands. In preliminary experiments using a cisplatin-resistant cell culture, Platin-M nanoparticles were 17 times more active than cisplatin alone.

“This technique could become a treatment for a number of cancers, but it may prove most useful for more aggressive forms of cancer that are resistant to current therapies,” said Pathak.

Both Dhar and Pathak caution that their experimental results are preliminary and they must do more work before Platin-M enters any clinical trials. However, their early results in mouse models are promising, and they are currently developing safety trials in larger animals.

“Cisplatin is a well-studied chemotherapy, so we hope our unique formulation will enhance its efficacy,” said Dhar, who is also a member of UGA’s Nanoscale Science and Engineering Center, Center for Drug Discovery, and Regenerative Bioscience Center. “We are excited about these early results, which look very promising.”

 

http://www.medicalnewstoday.com/releases/279303.php

Picture courtesy of www.sciencedaily.com