PURPOSE:Based on bioeffect modeling of published outcomes after radiation therapy for head and neck squamous cell carcinoma with various time-dose-fractionation, we hypothesized that a 20-fraction hypofractionated (HFX) schedule delivering 55 Gy in 20 fractions, 5 fractions per week, over 4 weeks would be noninferior to a 33-fraction accelerated, normofractionated (NFX) 2 Gy per fraction schedule, delivering 66 Gy in 2-Gy fractions, 6 fractions per week over 5.5 weeks with respect to both local tumor control and late adverse events. METHODS AND MATERIALS:The HYPNO (HYPo-fractionated vs NOrmo-fractionated radiation therapy for head and neck squamous cell carcinoma) trial was designed as a multicenter, pragmatic, embedded, 2-arm, unblinded, randomized controlled noninferiority trial with dual primary endpoints, loco-regional tumor control, and grade 3 or higher late adverse events with a 10% noninferiority margin for both endpoints. The trial was open for enrollment in 12 centers, each adhering to their standard of care to the extent that it was consistent with the requirements of the trial protocol. Concurrent chemoradiation therapy with 35 mg/m2 cisplatin weekly was permitted. RESULTS:Between March 2014 and February 2020, 792 patients were centrally randomized: 395 to HFX and 397 to NFX. Accrual closed, with all outcome data still blinded, with 792 of a planned 836 patients (94.7%) enrolled, in part due to the emerging COVID-19 pandemic. The HYPNO test arm passed the separate noninferiority tests for both loco-regional tumor control (P = .04) and grade 3+ late adverse events (P = .004). At 3 years, the absolute difference in outcome between the 2 arms was ≤1.4 percentage points for overall survival, progression-free survival, loco-regional control, and grade 3+ late adverse events. The planned subgroup analyses showed no statistically significant heterogeneity of effect estimates for loco-regional control between the 2 trial arms. CONCLUSIONS:The HYPNO test arm schedule was shown to be noninferior with respect to both loco-regional tumor control and grade 3+ late adverse events.
La lumbalgia en niños y adolescentes es una patología frecuente, con una prevalencia anual del 7% al 58%. Es más frecuente entre los 13 y 15 años. Se espera que el 10% al 30% de la población joven sana sufra un episodio de dorsolumbalgia al llegar a la adolescencia(1). La mayoría de las causas de dolor lumbar son benignas, pero es importante descartar patologías potencialmente graves como son las infecciones. La artritis facetaria es una afección rara, pero potencialmente grave, siendo la presentación en edad pediátrica poco frecuente. De diagnóstico generalmente tardío, frecuentemente la sintomatología no es clara por lo que se debe tener alta sospecha; un examen físico completo es fundamental, así como los estudios de laboratorio e imagen donde la resonancia magnética cumple un rol fundamental en el diagnóstico. El primer caso fue descripto por Halpin en 1987, desde entonces se han reportado en literatura alrededor de 100 publicaciones, encontramos 10 en edad pediátrica. Representa alrededor del 4% de las infecciones vertebrales, aunque muchas veces pasa desapercibida. La localización más frecuente es a nivel lumbar. La vía hematógena es la más frecuente, aunque también se han reportado casos de inoculación directa(2). Describiremos el caso de una niña de 5 años y su evolución a 5 años con diagnóstico de artritis facetaria L3-L4 a izquierda. Presentaremos directivas terapéuticas en base a una revisión de la bibliografía actualizada.
Introducción: La luxación congénita de rodilla es una patología infrecuente caracterizada por hiperextensión y desplazamiento anterior de la tibia, con una incidencia estimada de 1/100.000 nacidos vivos. Su etiología es multifactorial y puede presentarse de forma aislada, asociada a otras deformidades musculoesqueléticas o formando parte de síndromes complejos. Caso clínico: Presentamos un paciente masculino diagnosticado prenatalmente con genu recurvatum bilateral. Al nacimiento se realizo diagnóstico de luxación congénita bilateral de rodillas grado III. Fracasado el tratamiento ortopédico mediante manipulación y yesos seriados, se realizó reducción abierta bilateral sin reparación del aparato extensor. El posoperatorio cursó favorablemente, con recuperación de la función del cuádriceps, adquisición progresiva del desarrollo motor y marcha autónoma a los 17 meses. Conclusión: La luxación congénita de rodilla, aunque infrecuente, requiere diagnóstico y tratamiento tempranos. La reducción abierta sin reparación del aparato extensor puede constituir una alternativa válida en casos graves, con resultados funcionales satisfactorios.
PURPOSEThe timely diagnosis and referral of children with cancer have been identified as a priority for pediatric oncology. Despite the prominence of timely detection educational interventions, scant data exist on the approach and efficacy of these trainings.METHODSFor this scoping review, PubMed, Web of Science, Scopus, and SciELO were searched to identify studies reporting on educational interventions for the timely detection of pediatric patients with cancer.RESULTSOur search yielded 5,682 studies, and 29 met the inclusion criteria. These studies captured experiences from 20 countries. Interventions were most frequently conducted in person (12 of 29, 41.4%), with varying formats including workshops (10 of 29, 34.5%), multiday courses (5 of 29, 17.2%), and lectures (4 of 29, 13.7%). Seven studies (24.1%) reported the use of supplementary materials such as job aids, posters, or flyers. Interventions focused on increasing recognition of the signs and symptoms of childhood cancers (25 of 29, 86.2%), whereas some addressed referral practices (11 of 29, 37.9%). Audiences were varied, but included physicians (23 of 29, 79.3%) most often. Most studies (28 of 29, 96.6%) evaluated the impact or outcomes of their educational interventions. Most studies assessing the impact reported the number of participants trained (23 of 29, 79.3%). Knowledge assessment was conducted immediately in 11 studies (37.9%). Additional outcomes included the number of patient referrals (9 of 29, 31.0%), the number of new childhood cancer cases (4 of 29, 13.8%), time to diagnosis (4 of 29, 13.7%), and the stage distribution of cancers at diagnosis (6 of 29, 20.7%).CONCLUSIONOur review highlights the potential of educational interventions to improve provider knowledge and referral practices in childhood cancer diagnosis. Yet, current interventions vary widely in scope, content, and outcome measures. Further research is needed to address methodological limitations and ensure that greater awareness yields meaningful improvements in pediatric cancer outcomes worldwide.
