Purpose Post-treatment PET-CT is obtained after chemoradiation (CRT) for locally advanced anal canal cancer (LAACC) patients, yet its prognostic utility remains uncertain. We hypothesized that quantitative PET-CT metrics predict overall survival (OS), and that pre-treatment metabolic parameters stratify risk better than post-treatment response alone in LAACC pts treated with CRT. Methods We conducted a retrospective cohort study of LAACC pts who underwent definitive CRT and pre and post-treatment fluorodeoxyglucose (FDG) PET-CT. Quantitative PET metrics were extracted, including mean SUL, total lesion glycolysis (TLG), metabolic tumor volume (MTV), and SULpeak. OS was estimated via Kaplan-Meier methods. Cox proportional hazards regression with MaxStat methodology evaluated associations between FDG PET-derived variables and OS. Results Forty-five patients were included (median age 57.7 years), with median post-treatment imaging follow-up time of 4.4 months. Lean body mass (HR 3.10, 95% CI 1.01–9.50; p = 0.049) and pre-treatment primary tumor mean SUL (HR 4.93, 95% CI 1.40–17.37; p = 0.013), size (HR 4.01, 95% CI 1.22–13.17; p = 0.022), TLG (HR 3.68, 95% CI 1.11–12.14; p = 0.033), and SULpeak (HR 3.31, 95% CI 1.02–10.72; p = 0.046) were significantly correlated with OS. Post-treatment, higher weight (HR 4.94, 95% CI 1.06–22.96; p = 0.041; cutoff 60.42 kg; N = 45) and lean body mass (HR 4.82, 95% CI 1.06–21.90; p = 0.042; cutoff 44.50 kg; N = 44) predicted worse survival. No post-treatment PET-CT metrics showed statistical significance in predicting OS. Conclusion Many pre-treatment, but not post-treatment, PET-CT metrics predicted OS. Baseline tumor metabolic activity may thus inform prognosis more reliably than post-treatment metrics.

INTRODUCTION:Consensus contouring guidelines for intensity-modulated-radiation-therapy (IMRT) of patients with locally advanced cervix cancer (LACC) advise including the whole uterus in the target volume and adding generous planning-target-volumes (PTVs) to account for motion uncertainties of the gross-tumor-volume (GTV). The primary objective of this analysis was to assess the interfractional GTV motions using a magnetic-resonance-image (MRI) guided-Radiation-Therapy (MRgRT) system to investigate the margins required for MRgRT treatments. METHODS:125 daily set-up MRIs from five patients with LACC who received MRgRT were analyzed. The GTV, bladder, uterus, and rectum were contoured on all 125 MRIs. Tumor volume changes were calculated in cubic-centimeters (cc). The positional and volume changes of organs-at-risk (OARs) were calculated to assess their effect on GTV interfractional motion, these data were used to calculate adequate PTV margins. RESULTS:The tumor volume decreased in size during the course of MRgRT for all patients, from 34.0 % to 85.2 %. The interfractional average GTV displacement ranged from 0.46 cm to 0.94 cm. The PTV margins required were: 0.78 cm Left-Right, 1.31 cm Anterior-Posterior and 1.38 cm for the Superior-Inferior directions. The proposed PTV margins, compared to those recommended by consensus guidelines, reduce the PTV by 38 % sparing both the sigmoid and bowel OARs. CONCLUSIONS:By utilizing daily onboard MRI guidance, the GTV becomes readily visualized, allowing for margin reduction and potentially excluding a portion of the uterine fundus from the PTV. The amount of interfractional motion demonstrated in this study is considerable and clinically significant with the goal of decreasing treatment toxicity while maintaining tumor control. SUMMARY:Daily pretreatment magnetic resonance images (MRIs) from patients with locally advanced cervix cancer (LACC) treated with on-board MR-guided radiation therapy (MRgRT) were analyzed to quantify the range of interfractional motion and develop target volume guidelines for adaptive MRgRT. MRI-guidance leads to better tumor visualization in comparison to cone beam computed tomography (CBCT), and online adaptive planning can account for the interfraction motion of the tumor and surrounding tissue. MRI's ability to better visualize the disease and pelvic anatomy along with adaptive on-board MRgRT could allow for a reduction in the required setup margins as well as potentially excluding non-diseased portions of the uterus from the target volumes. These changes will lead to reduced treatment volumes and may lead to decreased treatment toxicities and allow for dose escalation in certain circumstances.

Background: Inadequate representation of women and racial minorities in heart failure (HF) clinical trials continues to limit the generalizability of the results. This could create a disparity in treatment for future heart failure therapies and devices. The study aims to assess the representation of women and racial minorities in recent heart failure studies involving sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Methods: PubMed was used to search randomized controlled trials (RCTs) looking at SGLT-2 inhibitors and heart failure, which were published from inception to August 2024. Results: A total of 43 RCTs with 27,703 participants were identified. The studies were published between 2018 and 2024. Seven studies (41 %) were multi-country, with 45 countries represented. The overall proportion of women enrolled in the studies was 35.6 %. The proportion of women was 24.06 % in studies that recruited only patients with HFrEF, 44.33 % in those that recruited only patients with HFpEF, and 41.4 % in those that recruited both HFrEF and HFpEF. Data on race was partially reported in 25 studies (58 %). 76 % of the pharmaceutical industry-funded studies reported race data. However, only 33.3 % of the unfunded or non-industry-funded studies reported race data. In the studies that reported race data, 72.91 % were Caucasians, 15.48 % were Asians, 5.62 % were African-American and 4.1 % were mixed race or others. In the bivariate analysis, race was more likely to be reported in studies done in the US (p < 0.001), multi-country studies (p = 0.013), and studies sponsored by pharmaceutical companies. More than a third of the study participants were more likely to be women in more recently published studies than older studies (p < 0.001). Additionally, more than a third of the study participants were more likely to be women in studies done in the US (p = 0.055). The multivariate analysis showed an increased odds of having more than a third of the study participants being women in more recently published studies (OR 1.83, 95 % CI 1.06-3.17, p = 0.031) and in studies done in the US (OR 7.69, 95 % CI 1.53-38.59, p = 0.013). Conclusion: Our study found that women and racial minority individuals have remained underrepresented in recent heart failure studies. Although some progress has been made over the years, more work is needed to improve data reporting and address barriers to enrollment for women and racial minority individuals in clinical trials.

PURPOSE:The purpose of this study was to determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures. METHODS AND MATERIALS:A 27-item survey created with expertise from 5 brachytherapists was distributed electronically to 90 U.S. radiation oncology academic programs and publicized on social media and at 2 national meetings from June to October 2023. RESULTS:Forty-one responses were received (46%). Fifty-four percent identified as female, 66% as Caucasian, and 85% as non-Hispanic/Latino ethnicity. Forty-nine percent use a BT suite ± computed tomography (CT) simulator alone, 39% the operating room ± BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic examination room. Thirty-four percent use general anesthesia alone (GA) for intracavitary BT (n = 41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n = 25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, 4% OA alone, and 28% combination. For template interstitial BT (n = 25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, whereas 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were the lack of AS resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder symptoms after BT. However, 68% reported not using techniques to alleviate BT-related emotional distress. CONCLUSIONS:Many U.S. brachytherapists report using GA, CS, or epidural AS; however, 10% are using only OA, and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe post-traumatic stress disorder symptoms can occur after BT, but few offer any intervention. AS resources and clinician preferences should be targeted for the expansion of higher-quality care.

Purpose To determine the current practice patterns of analgesia (AG) and anesthesia (AS) use across the U.S. for gynecologic brachytherapy (BT) procedures. Methods and Materials A 27-item survey was created with expertise from five practicing radiation oncology brachytherapists in the U.S. and distributed electronically to 90 Radiation Oncology residency programs for dissemination. The survey was also publicized on social media via the X (formally Twitter) platform, and at two national meetings (The American Brachytherapy Society Annual Meeting 2023 and The American Society for Radiation Therapy Annual Meeting 2023) during the months of June-October 2023. Results Forty-one responses were received (46% response rate). Fifty-four percent identified as female, 66% Caucasian race and 85% of non-Hispanic/Latino ethnicity. Ninety-three percent were physician brachytherapists, 5% medical physicists, and 2% did not disclose their profession. Forty nine percent reported typically carrying out procedures in a BT suite ± separate CT simulator alone, 39% in the operating room ± BT suite or CT simulator or other location. Ten percent reported the CT simulation room alone, and 2% in a clinic exam room. The number of cervix BT courses most frequently performed per month was between 0 and 5 at 61%, and 44% reported an average of five applicator placements per course (range 0-5). Thirty four percent reported using general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone. The remaining responses were combinations of AG or AS (see table 1). Hybrid intracavitary/interstitial BT applicators are being used by 61% of respondents, 49% of which are vendor made devices (e.g., Elekta/Varian). Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone. The remaining responses were combinations of AG or AS. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of all respondents report providing AG or AS during applicator placement only, while 32% report offering it during placement, planning, treatment, and removal. The most commonly cited reason for not using CS or GA was lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to help alleviate emotional distress related to BT procedures. Conclusions AG/AS practice patterns for gynecologic BT vary widely across the United States. While many clinicians report using some form of GA, CS or epidural AS, 10% are using only oral analgesia methods, and 22% are offering AG/AS only during applicator placement. Furthermore, 73% of respondents believe patients suffer from PTSD symptoms after BT, but only 32% report use of techniques to help alleviate this. AS resources and clinician preference are areas that should be targeted for expansion of higher quality care.

Background: Limited donor organ availability necessitates the use of mechanical circulatory support (MCS) as a bridge to transplant for patients in medically refractory end-stage heart failure. The increasing availability, flow capability and durability of the Impella 5.5 percutaneous LVAD has benefitted patients with its minimally invasive nature. We present a single-center case series of patients supported with Impella 5.5 to OHT, demonstrating the safety and feasibility of this approach in what is, to our knowledge, the largest reported series to date. Methods: From January 2021 to present, 31 consecutive patients supported by Impella 5.5 underwent OHT at our institution. Demographic data, etiology of illness, details of procedures, duration of support, postoperative complications, and outcomes were analyzed. We additionally report two different methods of complete device removal during OHT – via device transection in the field versus removal from the axillary insertion site. Results: Of 31 patients, 80.7% (25/31) were male and the average age was 49.5 (21-70) years. The etiology of cardiomyopathy was predominantly nonischemic in 77.4% (24/31) of patients. Average length of stay was 78.2 days (27-229) with an average 53.1 days (19-133) in the intensive care unit. 27 patients (87.1%) had device placed in the right axillary artery, with 3 being on the left. Average Impella 5.5 duration was 29.6 days (2-97). During OHT, 67.7% (21/31) had device transected in the aorta and sent off the field, while the remaining 32.3% had device removal via axillary site. 8 patients (25.8%) underwent multiple organ transplant (7 kidney, 1 liver). Two patients (6.5%) suffered neurological insult. Notably, in both cases, the device was removed via the second method. There was 1 vascular complication, requiring axillary artery repair. Three patients (9.7%) had postoperative acute kidney injury or renal failure. Average days from OHT to discharge were 26.0 (7-80). There was 1 death in a patient who developed mixed septic and cardiogenic shock, and another death in a patient who developed a mediastinal infection several months postoperatively. The 30-day survival rate was 96.8% (30/31). 6.5% (2/31) patients had concern for rejection. Eleven patients (35.5%) were alive at 1 year, while another 18 (58.0%) were alive but had not yet reached 1 year post-transplant. Conclusion: Based on our institutional experience, Impella 5.5 is safe and reliable for prolonged bridge to OHT, as demonstrated in the high 30-day and 1-year survival rates. Complication rates were relatively low while offering a minimally invasive approach and avoiding resternotomy at time of OHT. We speculate that device removal via transection in the ascending aorta poses a lower stroke risk than the more established alternative, but further work will need to demonstrate superiority of either technique. Finally, further studies are needed urgently to determine the optimal MCS approach in patients awaiting OHT. Table 1. Prolonged Impella 5.5 Support as Bridge to Transplant

Introduction: Several clinical studies including a large multiethnic population (Dallas Heart Study) have shown that total arterial compliance (TAC) and aortic arch pulse wave velocity (PWV aa ) are predictors of cardiovascular disease (CVD) events. Dallas Heart Study also showed that PWV aa predicts brain white matter hyperintensity volume independent of cardiovascular risk factors. Recently, Intrinsic Frequency (IF) analysis of carotid pressure waveform from the Framingham Heart Study was used to predict heart failure (HF) events and CVD (Hypertension, 2021 PMID: 33390053). Aim: Our goal was to show the IF method can determine PWV aa and TAC when applied on carotid pulse waveforms obtained from a standard iPhone camera. Methods: The clinical cohort consisted of 120 individuals (40% women) with ages from 20-92 yrs (mean 53 ± 18), including 54 healthy and 66 patients with CVD (22 HF). Phase-contrast magnetic resonance imaging (PC-MRI) and carotid pressure tonometry data were used to compute TAC. PWV aa values were obtained using PC-MRI flow in ascending and descending aorta (not achieved in 1 patients). A custom Apple iPhone 5S application was used to obtain carotid pulse waves by holding the camera against the neck. IF parameters of iPhone waveforms (calibrated by cuff brachial pressures) were used in machine learning algorithms (IF-iPhone). The models of TAC and PWV aa were developed using 100 participants (99 for PWV aa ) and blindly tested on an additional 20 individuals. Results: In blind tests, iPhone-IF models showed Pearson correlations of r=0.89 and r=0.84 with the measured values of TAC and PWV aa , respectively (Fig.1). Conclusions: Assessment of PWV aa and TAC can be accurately achieved using an unmodified smartphone (iPhone). PWV aa evaluation with an iPhone can be used to identify, predict, and quantify risk of vascular brain damage. A Noninvasive iPhone-based method can be used in a clinical or home setting to routinely assess TAC in the general population or in HF.

Introduction: The significance of ventricular-arterial coupling (VAC) in understanding the pathophysiology of heart failure (HF) and other cardiovascular diseases is well-established. Recent studies suggest that evaluation of VAC via assessment of left ventricle (LV) pulsatile workload (LVPW) may be useful in diagnosing HF with preserved ejection fraction (HFpEF). In addition, several studies have indicated that abnormal pulsatile hemodynamics is one of the key characteristics of HFpEF. Specifically, a higher pulsatile load is identified as one of the main causes of HFpEF in older women. Assessment of the LVPW requires measurement of both pressure and flow waves. Our aim in this study is to develop a new method for evaluation of LVPW in HFpEF (and HF in general) using only noninvasive carotid pressure waves (without flow or velocity measurement). Method: Our method combines intrinsic frequency (IF) of a carotid pressure wave form with machine learning (IF-ML) to develop a hybrid model that approximates LVPW. The model was developed using 80% of Framingham Heart Study (n=6538, 53% female, age range 19-90). The IF-ML model was blindly tested on the remaining 20% of Framingham data. The final model was evaluated among HFpEF patients (n=38) and all HF patients (n=82). Result: The Pearson correlation coefficient (R) between single waveform LVPW and measured LVPW was 0.91 and 0.89 among HFpEF and all HF respectively (Fig.1). In blind-tested general population R=0.88. Conclusion: Single pressure waveform assessment of LVPW can improve the utility of LV pulsatile hemodynamic assessment in diagnosis and monitoring of HFpEF patients.

Brachytherapy is an integral part of the definitive treatment for locally advanced cervical cancer following external beam radiation therapy. Placement of brachytherapy applicators is an important skill for radiation oncologists and care must be taken to place applicators appropriately to limit complications associated with the procedure and ensure that the radiation dose sufficiently covers the target while sparing the surrounding organs at risk. Using example cases, we discuss strategies for the placement of brachytherapy applicators in patients with anatomical considerations such as large obstructing uterine fibroids and the retroverted uterus. We also discuss the management of uterine perforation during applicator placement and approaches to patients with a poor response to external beam radiation therapy before brachytherapy delivery. We draw upon the available literature and our clinical experience to suggest approaches to these challenging scenarios.

Objective Delay in initiating cervical cancer treatment may impact outcomes. In a cohort of patients initially treated by surgery, chemoradiation, chemotherapy, or in a clinical trial, we aim to define factors contributing to prolonged time to treatment initiation. Methods Data from patients initiating treatment for cervical cancer at a single institution was abstracted. Time to treatment initiation was defined as the interval from the date of cancer diagnosis to the date of treatment initiation. Poisson regression model was used for analysis. Results Of 274 patients studied, the median time to treatment initiation was 60 days (range 0–551). The median times to initiate surgery (54 days, range 3–96) and chemoradiation (58 days, range 4–187) were not significantly different (relative risk (RR) 1.01, 95% CI 0.98 to 1.04, p=0.54). The shortest median initiation time was for chemotherapy (47 days; RR 1.13, 95% CI 1.08 to 1.19, p<0.0001) and the longest was for clinical trial (62 days; RR 1.18, 95% CI 1.12 to 1.24, p<0.0001). Charity care (RR 1.09, 95% CI 1.05 to 1.14, p<0.0001), Medicare or Medicaid (RR 1.10, 95% CI 1.06 to 1.14, p<0.0001), and self-pay (RR 1.38, 95% CI 1.32 to 1.45, p<0.0001) delayed treatment initiation more than private insurance. Hispanic White women (RR 0.69, 95% CI 0.66 to 0.73, p<0.0001) had a shorter treatment initiation time compared with non-Hispanic White patients, while Afro-Caribbean/Afro-Latina women (RR 0.86, 95% CI 0.81 to 0.90, p<0.0001) and African-American patients (RR 1.13, 95% CI 1.07 to 1.19, p<0.0001) had longer initiation times. Spanish speaking patients did not have a prolonged treatment initiation (RR 0.68, 95% CI 0.66 to 0.71, p<0.0001), though Haitian-Creole speaking patients did (RR 1.07, 95% CI 1.01 to 1.13, p<0.002). Diagnosis at an outside institution delayed treatment initiation time (RR 1.24, 95% CI 1.18 to 1.30, p<0.0001) compared with diagnosis at the cancer center. Conclusion Factors associated with prolonged time to treatment initiation include treatment modality, insurance status, language spoken, and institution of diagnosis. By closely examining each of these factors, barriers to treatment can be identified and modified to shorten treatment initiation time.

OBJECTIVES:To examine the efficacy and safety of radiotherapy for the prevention of heterotopic ossification (HO) about the elbow.DESIGN:Retrospective chart review.SETTING:Level 1 trauma center.PATIENTS/PARTICIPANTS:Two hundred and twenty-nine patients who received prophylactic radiotherapy (XRT) over a 15-year period were identified. Patients were included if they received XRT to the elbow joint and had at least 12 weeks of follow-up after XRT. Fifty-four patients were ultimately included.INTERVENTION:All patients were treated with a single dose of 7 Gy. Ninety-eight percentage of patients received XRT within 24 hours after surgery, and all patients received XRT within 72 hours after surgery.MAIN OUTCOMES MEASUREMENTS:The primary study measures evaluated were the presence or absence of clinically symptomatic HO and the presence of radiographic HO after XRT to the elbow joint.RESULTS:Eighteen patients were treated with XRT after a traumatic injury requiring surgery (primary prophylaxis), and 36 were treated with XRT after excision surgery to remove HO which had already formed (secondary prophylaxis). In the primary cohort, 16.7% developed symptomatic HO after XRT and 11.1% required surgery to resect the heterotopic bone. In the secondary cohort, 11.1% developed symptomatic HO after surgery and XRT and 5.5% required resection surgery. No secondary malignancies were identified.CONCLUSIONS:Our findings suggest that XRT for elbow HO may be safe and effective for both primary and secondary HO. XRT for HO was not shown to be associated with radiation-induced sarcoma in this series, at least in the short term. Further study in a large patient population with extended follow-up is required to better characterize populations at high risk for development of HO and secondary malignancy.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prophylactic radiotherapy (XRT) is a commonly used treatment to decrease heterotopic ossification (HO) in patients with traumatic hip injuries. We conducted a retrospective review of patients at risk for HO who underwent XRT. Of the patients reviewed, 27.3% developed radiographic HO, 11.2% developed symptoms, and 2.0% required resection surgery. Patients were divided into primary (n = 71) and secondary prophylaxis (n = 27) cohorts. In the primary group, 25.0% developed radiographic HO, 5.6% developed symptoms, and 0 required surgery. In the secondary cohort, 33.3% of patients developed new radiographic HO, and 25.9% were symptomatic: four had a Brooker score of 3, and three had a score of 4 (p = 0.03), and 7.4% required surgical resection. (Journal of Surgical Orthopaedic Advances 31(2):113-118, 2022).

The authors regret that the version of Table 3 originally published in this article was incorrect. The online version has now been updated and the correct table can be found below. The authors would like to apologise for any inconvenience caused. Table 3. Comparison of 3 yr RFS, nomogram recurrence risk, and Sedlis criteria for predictor variable combinations.Tabled 1Vascular InvasionInvasion DepthTumor SizeSCCACRFS (3 yr, CI)Sedlis Criteria (+/−)nomogram recurrence riskRFS (3 yr, CI)Sedlis Criteria (+/−)nomogram recurrence riskNSuperficial(< 2 cm)0.98 (0.96,1)−<5%0.96 (0.90, 1.00]−<5%NMiddle(< 2 cm)0.91 (0.87,0.95)−9%0.97 (0.92, 1.00]−<5%NDeep(< 2 cm)0.86 (0.79,0.93)−16%0.95 (0.87, 1.00]−7%NSuperficial(2–4 cm)0.97 (0.95,1)−<5%0.86 (0.70, 1.00]−14%NMiddle(2–4 cm)0.88 (0.84,0.93)−11%0.89 (0.77, 1.00]−11%NDeep(2–4 cm)0.82 (0.75,0.89)−18%0.83 (0.66, 1.00]−17%NSuperficial(≥ 4 cm)0.94 (0.9,0.99)−10%0.81 (0.59, 1.00]−19%NMiddle(≥4 cm)0.78 (0.7,0.86)+18%0.85 (0.70, 1.00]+16%NDeep(≥ 4 cm)0.66 (0.58,0.75)+25%0.77 (0.56, 1.00]+22%YSuperficial(< 2 cm)0.97 (0.94,0.99)−<5%0.88 (0.71, 1.00]−15%YMiddle(< 2 cm)0.86 (0.8,0.92)−12%0.91 (0.78, 1.00]−12%YDeep(< 2 cm)0.78 (0.7,0.88)+20%0.85 (0.70, 1.00]+18%YSuperficial(2–4 cm)0.96 (0.92,1)−6%0.65 (0.32, 1.00]−32%YMiddle(2–4 cm)0.82 (0.76,0.89)+14%0.71 (0.48, 1.00]+29%YDeep(2–4 cm)0.73 (0.65,0.81)+21%0.58 (0.36, 0.96]+35%YSuperficial(≥ 4 cm)0.91 (0.84,0.99)+16%0.55 (0.19, 1.00]+39%YMiddle(≥ 4 cm)0.67 (0.57,0.79)+24%0.63 (0.37, 1.00]+36%YDeep(≥ 4 cm)0.52 (0.43,0.64)+31%0.47 (0.24, 0.95]+42% Open table in a new tab Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysisGynecologic OncologyVol. 162Issue 3PreviewThe Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment. Full-Text PDF

PurposePre-transplant employment status has been shown to be a good prognosticator of post-transplant outcomes in certain organ transplant populations. We sought to evaluate the effect of working status on heart transplant (HT) recipients at the time of transplant on long-term survival.MethodsWe performed a retrospective analysis of 31,597 first time HT recipients from the UNOS registry from 2004-2020. Comparisons between patient characteristics of HT recipients working at time of transplant (N=2696) and those not working (N=28,901) were made using standard statistical methods. Cox proportional hazards regression model was applied to adjust for covariates that could confound post-transplant survival analysis.ResultsHT recipients who were working at time of transplant were more likely to be younger (52.0 ± 11.8 vs 53.5 ± 12.5, p <0.001) and male (77.1% vs 74.2%, p <0.001). This group had fewer comorbidities, with lower rates of diabetes (21.6% vs 27.7%, p<0.001), prior non-transplant cardiac surgery (34.9% vs 38.2%, p<0.001), dialysis requirement (1.1% vs 1.9%, p=0.004), and smoking (39% vs 47.9%, p<0.001). The working HT recipients had lower rate of life support use at time of transplant, particularly with IABP use (10.5% vs 8.6%, p=0.001). There was no difference in the median time on the wait list, and working recipients were less likely to be in a higher status listing. There was lower overall post-heart transplant mortality in the working recipients compared to the non-working recipients in the 150 months follow-up period (p<0.001). Working at time of transplant was associated with decreased mortality (HR=0.78, 95% CI 0.71 to 0.86).ConclusionHT recipients who were working at the time of their transplant tended to be younger with fewer co-morbidities. These patients' peri-operative acuity also tended to be lower. Working HT recipients had better long-term survival compared to non-working HT recipients. These findings suggest that more consideration should be given to work status as part of heart transplant candidacy evaluation. Pre-transplant employment status has been shown to be a good prognosticator of post-transplant outcomes in certain organ transplant populations. We sought to evaluate the effect of working status on heart transplant (HT) recipients at the time of transplant on long-term survival. We performed a retrospective analysis of 31,597 first time HT recipients from the UNOS registry from 2004-2020. Comparisons between patient characteristics of HT recipients working at time of transplant (N=2696) and those not working (N=28,901) were made using standard statistical methods. Cox proportional hazards regression model was applied to adjust for covariates that could confound post-transplant survival analysis. HT recipients who were working at time of transplant were more likely to be younger (52.0 ± 11.8 vs 53.5 ± 12.5, p <0.001) and male (77.1% vs 74.2%, p <0.001). This group had fewer comorbidities, with lower rates of diabetes (21.6% vs 27.7%, p<0.001), prior non-transplant cardiac surgery (34.9% vs 38.2%, p<0.001), dialysis requirement (1.1% vs 1.9%, p=0.004), and smoking (39% vs 47.9%, p<0.001). The working HT recipients had lower rate of life support use at time of transplant, particularly with IABP use (10.5% vs 8.6%, p=0.001). There was no difference in the median time on the wait list, and working recipients were less likely to be in a higher status listing. There was lower overall post-heart transplant mortality in the working recipients compared to the non-working recipients in the 150 months follow-up period (p<0.001). Working at time of transplant was associated with decreased mortality (HR=0.78, 95% CI 0.71 to 0.86). HT recipients who were working at the time of their transplant tended to be younger with fewer co-morbidities. These patients' peri-operative acuity also tended to be lower. Working HT recipients had better long-term survival compared to non-working HT recipients. These findings suggest that more consideration should be given to work status as part of heart transplant candidacy evaluation.