Anchoring to the diagnosis of COVID is easy to do in the setting of the unprecedented uncertainty of the current pandemic. It is for this reason we hope the applied statistics in this case will give providers a practical framework for contextualizing multiple negative RT-PCR tests for various patient populations. All authors participated in the construction and editing of the manuscript and its revisions.
National Center for Biotechnology Information , U. Respir Med Case Rep. Published online Aug Henry , a James A. Frank , b and Michael D. Hope a, c. Travis S. James A. Michael D. Author information Article notes Copyright and License information Disclaimer. Masis Isikbay: ude. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1.
Abstract Amidst the COVID pandemic, clinicians have been plagued with dilemmas related to the uncertainty about diagnostic testing for the virus. Introduction The spread of Coronavirus disease COVID has resulted in a global pandemic and has altered many aspects of daily practice both inside and outside of medicine. Case presentation An otherwise healthy year-old presented to the emergency department in April with three days of subjective fever, cough, chills, myalgia, and diarrhea.
Open in a separate window. Conclusion Anchoring to the diagnosis of COVID is easy to do in the setting of the unprecedented uncertainty of the current pandemic. Contributors All authors participated in the construction and editing of the manuscript and its revisions. Declaration of competing interest The authors declare that they have no conflict of interest. Appendix A. Supplementary data The following are the Supplementary data to this article: Multimedia component 1: Click here to view.
References 1. Coronavirus C. Centers for disease control and prevention. The institutional tumor board performed central review of each new case. Before the routine use of positron emission tomography PET imaging , staging was performed with computed tomography CT or magnetic resonance MR imaging along with abdominal ultrasound and bone scan. Owing to the retrospective nature of the study, the need for informed consent was waived. Patients with clinically positive nodal disease underwent level I—V neck dissections, whereas level I—III neck dissections were performed in presence of clinically negative nodes.
The procedures for collection and classification of pathologic risk factors and the indications for adjuvant treatment have been previously described in detail [ 16 , 17 ]. Patients received homogeneous treatment according to our institutional guidelines Supplementary Table 1.
The initial treatment volume comprised the primary tumor bed and the regional cervical nodes. Concurrent chemotherapy was offered to patients harboring adverse prognostic factors [ 17 ]. The performance status was calculated with the Eastern Cooperative Oncology Group scale. Alcohol consumption current or former drinkers versus nondrinkers and betel quid chewing current or former chewers versus non-chewers were also considered as dichotomous variables.
Chemotherapy was dichotomized as yes concurrent chemotherapy or chemotherapy administered in the 2 weeks preceding the start of RT versus no.
Preoperative PET imaging was dichotomized as yes versus no. The interval between surgery and RT was calculated from the date of surgery to the first RT session. OS — calculated as the time elapsed in years from the start of RT to the date of death — was the main outcome measure. LRC was defined as the time from the start of RT to the date of local or regional recurrence, whereas FFDM was the time elapsed from the start of RT to the date of diagnosis of distant metastases.
Survival curves were plotted with the Kaplan-Meier method log-rank test. The following covariates were entered into the multivariate model: age, sex, pT, pN, tumor differentiation, TPT, pattern of missed RT sessions early missed RT, late missed RT, RT as scheduled , cigarette smoking, betel quid chewing, alcohol consumption, presence of comorbidities, concurrent chemotherapy, and PET imaging. The median age of the study participants was There were 37 3.
Pathological nodal metastases were identified in patients Concurrent chemoradiation was administered to A total of There were , , and patients in the early missed RT, late missed RT, and RT as scheduled groups, respectively. The median duration of follow-up was 6. The 2-, 3-, and 5-year OS rates in the entire study cohort were In addition to other variables, early missed RT versus RT as scheduled was identified as a significant adverse predictor of OS. The present retrospective study demonstrates that early missed RT versus RT as scheduled was an independent adverse predictor of OS in a large cohort of patients with OCSCC enrolled in an endemic betel quid chewing area.
Moreover, early missed RT was independently associated with a higher occurrence of distant metastasis. Notably, late missed RT was an independent adverse predictor of local-regional control but not of OS. Taken together, our results indicate that the prognostic significance of missed sessions varies in relation to the course of RT — with early missing being independently associated with a less favorable OS.
The clinical outcomes of our patients who completed RT as scheduled were in line with those reported in previous studies [ 24 , 25 ]. Conversely, growing evidence indicates that deviations from originally scheduled RT plans predict poor outcomes in patients with solid malignancies [ 26 , 27 ]. A prolonged TPT has been previously associated with less favorable survival figures in head and neck malignancies [ 25 ]. Another report identified a prolonged TPT as an adverse predictor of cancer-specific survival and FFDM in patients with locally advanced laryngeal cancer [ 31 ].
Based on the available literature, it remains difficult to identify the most useful parameter for RT treatment gaps in relation to clinical outcomes. By taking advantage of a large clinical cohort of OCSCC patients treated in a homogenous manner, we deliberately used a different approach to this problem. Specifically, we investigated the prognostic impact of missed sessions according to their temporal occurrence during the course of RT.
Our findings indicate that early missed — but not late missed — RT sessions have an adverse impact on OS. Late missed RT sessions were associated with a less favorable local-regional control.
While early missed sessions may exert a significant detrimental effect on survival possibly through an increased risk of distant metastases, only a trend was observed for late missed sessions. The association between early missed RT sessions and an increased occurrence of distant metastasis may be explained by the precocious effects elicited by radiation on target tissues — including alterations in immune response, cytokine signaling, and gene expression levels [ 32 , 33 , 34 ].
An escape of the tumor from such early effects may favor disease progression, which could account for the unfavorable prognostic significance attributable to early missed RT both in terms of OS and distant metastases. The RT-induced tissue effects elicited by initial sessions seem therefore to have a paramount prognostic significance, although the molecular underpinnings underlying this phenomenon deserve further scrutiny.
The reasons for missing RT sessions can depend on the patient e. In general, early missed RT sessions are unlikely to be caused by treatment toxicity — whose onset generally occurs following at least 3 weeks of treatment [ 35 ]. Our current data highlight the importance of compensatory strategies when unexpected deviations from the original RT plan occur.
Strategies to achieve this goal include 1 the delivery of compensatory RT sessions on weekends aimed at preserving the originally planned treatment duration, total dose, and dose per fraction, 2 an increased number of daily fractions e.
Our findings need to be interpreted in the context of some limitations. First, the retrospective nature of our investigation is inherently subjected to selection biases and recall biases. Second, we cannot rule out residual confounding effects due to unmeasured variables. Additionally, this is a single-institution study that may have limited external validity because it was conducted in betel quid chewing endemic area. Findings from single-center investigations are not necessarily generalizable to all patients with OCSCC because of different institutional practices and disparate patient populations.
Independent confirmation of our findings is necessary before drawing more definitive conclusions. These caveats notwithstanding, our current data indicate that early missed RT was independently associated with less favorable outcomes in patients with OCSCC who had previously undergone surgery. Efforts to maximize early adherence to RT can ultimately improve prognosis in this patient group.
The dataset on which the study is based are available from the corresponding author upon reasonable request. CA Cancer J Clin.
Google Scholar. Chu suggested. The CALGB trial results have been confirmed in a year update of that trial and in other recent studies. Chu said he hopes the message of when to withhold this breast cancer treatment receives better awareness in the community. Maybe it's time to ask your doctor, do I need radiation treatment for my breast cancer? Materials provided by American College of Surgeons. Note: Content may be edited for style and length. Science News. Those characteristics were as follows: age 70 or older stage I breast cancer measuring 2 cm or less roughly three-fourths of an inch or smaller that has not spread to the lymph nodes on clinical examination estrogen-receptor-positive tumor status the most common type of breast cancer surgical removal of the tumor with lumpectomy and negative surgical margins, meaning no more cancer is observed at the edge of the removed tumor subsequent long-term anti-hormone therapy such as tamoxifen They based this recommendation on their study finding that no difference existed in the length of overall survival of these elderly lumpectomy patients between those treated with and without postoperative RT plus tamoxifen.
Journal Reference : Quyen D. ScienceDaily, 27 January American College of Surgeons. Recommendation to omit radiation therapy after lumpectomy is not frequently implemented: Most elderly breast cancer patients who could skip radiation still get it.
Retrieved October 25, from www. Many women elect to undergo preventive surgeries that can ScienceDaily shares links with sites in the TrendMD network and earns revenue from third-party advertisers, where indicated. Print Email Share. Boy or Girl? Living Well.
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