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PURPOSE:Within a randomized clinical trial comparing partial breast irradiation (PBI) dosing schedules, we sought to determine whether shortening the radiation course would reduce financial toxicity (FT). METHODS AND MATERIALS:In a phase 3 trial of 778 women aged ≥40 years who underwent segmental mastectomy for early breast cancer at 12 US cancer centers, patients were randomized 1:1 to external beam PBI using 15-22 fractions (control, n = 385) versus 513 fractions (experimental, n = 393) (NCT03077841). FT was assessed using comprehensive, multi-item instruments and scored using the Economic Strain and Resilience in Cancer measure at baseline, end of radiation treatment (EoT), and 6- and 18-months after radiation on a scale of 0-100 (higher score indicated worse FT). Mixed linear multivariable regression estimated adjusted difference-in-differences between EoT versus baseline FT by treatment arm. Minimal important difference (MID) in Economic Strain and Resilience in Cancer score from baseline to EoT was estimated, anchored on change in patient-reported overall financial situation during that interval. RESULTS:Treatment arms had balanced clinical and sociodemographic characteristics. Median PBI duration was 22 days (IQR, 21-25) for the control arm versus 7 days (IQR, 5-10) for the experimental arm (P < .001). FT measures were completed for 96.1% of baseline and EoT assessments (n = 1496/1556). Adjusted improvement in FT score between baseline to EoT was -2.0 (95% CI, -3.6 to -0.4; P = .02) for the experimental versus control arm. Of 52 individual FT items assessed, 9 favored the experimental arm at EoT (P < .05), whereas none favored the control arm. MID in Economic Strain and Resilience in Cancer score was 2.2 (95% CI, 1.0-3.4). CONCLUSIONS:For patients with early breast cancer eligible for PBI, shortening the radiation duration by an average of 15 days yielded a reduction in end of treatment FT that was less than the MID estimated in this study.
Renal cell carcinoma (RCC) is characterized by a potential for unpredictable metastatic pattern and a capacity for delayed recurrence years after apparently curative surgical resection. Metastatic spread most commonly involves the lungs, bone, and lymph nodes, and involvement of the contralateral ureter is exceptionally rare, particularly when occurring as a true metachronous lesion years after primary tumor resection. Herein, we report a case of isolated contralateral distal ureteral metastasis identified 8 years after radical nephrectomy for RCC.
BACKGROUND:Cerebral venous thrombosis presents with diverse clinical features, making early recognition of patients at risk for deterioration challenging. The cerebral venous thrombosis score was developed by our group and later renamed the CLOTS-EVT score as a mnemonic to facilitate recall and improve ease of clinical use. This 10-point tool, including decreased consciousness (C), low platelets and sodium (L), absence of oral contraceptive use (O), thrombosis burden >3 sinuses (T), seizure (S), and papilledema (E), was developed to predict early deterioration and guide timely venous thrombectomy. We aimed to externally validate this score. METHODS:We retrospectively analyzed adults with cerebral venous thrombosis treated between 2015 and 2017 across 12 centers. Clinical, laboratory, and imaging data were collected, and the CLOTS-EVT score was applied to each patient. Predictive performance was evaluated using sensitivity, specificity, predictive values, and the area under the receiver operating characteristic curve. Correlation with functional outcome at discharge and hospital length of stay was assessed. RESULTS:Eighty patients were analyzed (median age, 38.5 years; 66% female). Headache was the most common symptom; oral contraceptive use was reported in one-third of women. Additional risk factors included pregnancy (7.5%), central nervous system infection (1.25%), malignancy (6.25%), hereditary thrombophilia (3.75%), and smoking (15%). The transverse and sigmoid sinuses were most frequently involved. Anticoagulation was initiated in nearly all patients; 10% underwent endovascular therapy. Overall, 63.8% achieved favorable outcomes, 80% were discharged home, and mortality was 3.8%. In this cohort, 41.3% had decreased consciousness, 47.5% had sodium <139 mEq/L, 38.8% had platelets <225 000/μL, 68.75% were not using oral contraceptives, 25% had thrombosis in >3 sinuses, 20% had seizures, and 22.5% had papilledema. A CLOTS-EVT score ≥4 predicted early deterioration with 82% sensitivity, 61% specificity, and an area under the receiver operating characteristic curve of 0.718. Higher scores correlated with longer hospital stay (r=0.325) and worse functional outcome (r=0.363). CONCLUSIONS:The CLOTS-EVT score demonstrated acceptable performance as a predictor of early deterioration in cerebral venous thrombosis. By combining standard clinical, laboratory, and imaging variables, it provides a practical tool for risk stratification and may inform consideration of venous thrombectomy alongside anticoagulation.
ABSTRACT Aim This study aims to assess the perception of urinary catheter use in older patients undergoing urologic and orthopaedic surgery and to explore the associated factors, specifically functional independence and knowledge. Design A cross‐sectional research design. Methods Patients were eligible if they were aged 65 and older, had received urological or orthopaedic surgery, were able to communicate independently, and had a urinary catheter. Data collection included demographics, voiding function history, health conditions, and the knowledge and perception of urinary catheter use. Multiple regression analysis was employed to investigate the variables associated with the perception of urinary catheter use. Results A total of 204 older patients were enrolled. The mean score of perception was 41.8 ± 2.7 (range 13–65). Lower perception scores (indicating a preference for catheterization) were observed for items related to mobility difficulties and incontinence. Multiple regression analysis revealed that older patients with greater independence in activities of daily living (ADLs) and better knowledge were significantly more likely to have a positive perception (i.e., recognizing the benefits of catheter removal and its risks). Conclusion Older surgical patients' perceptions of urinary catheter use are significantly shaped by their ADL status and knowledge levels. Although catheters are often viewed as a convenience for mobility and incontinence, such perceptions frequently misalign with evidence‐based safety standards. To optimize perioperative care, it is imperative to implement structured preoperative education and shared decision‐making frameworks that prioritize function‐based urinary management. Patient or Public Contribution This study incorporates older patients' perspectives by assessing their perceptions and knowledge of catheterization. The findings advocate for a transition toward function‐based management, where catheter alternatives are tailored to individual ADL status. By aligning clinical practice with patients' functional needs and informed preferences, healthcare providers can empower patients and reduce the risk of iatrogenic harm.
BACKGROUND Renal angiomyolipoma (AML) is a typically benign mesenchymal tumor with an indolent clinical course. Rarely, AML demonstrate aggressive vascular invasion, most commonly in association with tuberous sclerosis complex (TSC). Intracardiac extension, particularly into the right ventricle, is exceptionally uncommon in sporadic cases and presents significant diagnostic and surgical challenges. CASE REPORT A 36-year-old woman with a history of rheumatoid arthritis presented with progressive left upper-quadrant abdominal pain, nausea, and back discomfort. Cross-sectional imaging revealed a massive left renal angiomyolipoma measuring 19.5×18.0×10.5 cm, with a contiguous tumor thrombus extending from the left renal vein through the inferior vena cava into the right atrium, intermittently prolapsing across the tricuspid valve into the right ventricle. Echocardiography confirmed a mobile intracardiac mass without evidence of valvular obstruction. Genetic testing was negative for TSC1 and TSC2 mutations, consistent with a sporadic angiomyolipoma. The patient underwent successful en bloc left radical nephrectomy with complete venous thrombectomy and inferior vena cava reconstruction through a coordinated multidisciplinary approach. Final pathology confirmed complete excision with negative margins and absence of epithelioid features. CONCLUSIONS This case was an exceptionally rare presentation of sporadic renal angiomyolipoma with extensive intracardiac extension into the right ventricle. It demonstrates that significant vascular and cardiac involvement can occur even in the absence of TSC-associated genetic mutations or epithelioid histology, thereby challenging traditional assumptions regarding AML behavior. These findings underscore the importance of early recognition, comprehensive imaging, and individualized operative planning in the management of complex AML presentations. Given the potential for aggressive progression in otherwise benign tumors, close long-term radiographic surveillance remains essential.
