简介：Theriskofbreastcancer(BC)overdiagnosisattributedtomammographyscreeningisanunresolvedissue,complicatedbyheterogeneityinthemethodologyofquantifyingitsmagnitude,andbothpoliticalandscientificelementssurroundinginterpretationoftheevidenceonthisphenomenon.EvidencefromrandomizedtrialsandalsofromobservationalstudiesshowsthatmammographyscreeningreducestheriskofBCdeath;similarly,thesestudiesprovidesufficientevidencethatoverdiagnosisrepresentsaseriousharmfrompopulationbreastscreening.Forboththeseoutcomesofscreening,BCmortalityreductionandoverdiagnosis,estimatesofmagnitudevarybetweenstudieshoweveroverdiagnosisestimatesareassociatedwithsubstantialuncertainty.Thetrade-offbetweenthebenefitandthecollectiveharmsofBCscreening,includingfalse-positivesandoverdiagnosis,ismorefinelybalancedthaninitiallyrecognized,howeverthesnapshotofevidencepresentedonoverdiagnosisdoesnotmeanthatbreastscreeningisworthless.Futureeffortsshouldbedirectedtowards(a)ensuringthatanychangesintheimplementationofBCscreeningoptimizethebalancebetweenbenefitandharms,includingassessinghowplannedoractualchangesmodifytheriskofoverdiagnosis;(b)informingwomenofalltheoutcomesthatmayaffectthemwhentheyparticipateinscreeningusingwell-craftedandbalancedinformation;and(c)investinginresearchthatwillhelpdefineandreducetheensuingovertreatmentofscreen-detectedBC.

简介：PURPOSE:Weinvestigatethepatternsoffailureinthetreatmentofglioblastoma(GBM)basedonclinicaltargetvolume(CTV)marginsize,dosedeliveredtothesiteofinitialfailure,andtheuseoftemozolomideandintensity-modulatedradiotherapy(IMRT).METHODS:BetweenAugust2000andMay2010,161patientswithGBMweretreatedwithradiotherapywithorwithoutconcurrenttemozolomide.PatientsweretreatedwithCTVexpansionsthatrangedfrom5to20mmusingashrinkingfieldtechnique.PatternsoffailureandtimetoprogressionandoverallsurvivalwerecomparedbasedonCTVmargin,useoftemozolomide,anduseofIMRT.KaplanMeieranalysiswasusedtoestimatesurvivaltimes,andχtestwasusedforcomparisonofcohorts.RESULTS:Forpatientstreatedwith5-,10-,and15-to20-mmCTV,79%,77%,and86%experiencedfailuresinthe60Gyvolume,respectively.Forty-eightpercent,55%,and66%ofpatientswith5-,10-,and15-to20-mmCTVexperiencedfailuresinthe46Gyvolume,respectively.Therewasnostatisticaldifferencebetweenpatientstreatedwith5-,10-,15-to20-mmmarginswithregardto60Gyfailure(P=0.76),46Gyfailure(P=0.51),ormarginalfailure(P=0.73).Eightypercentofpatientsreceivingtemozolomideexperiencedfailuresinthe60Gyvolume.TherewasnoincreasedlikelihoodofmarginalfailuresinpatientsreceivingIMRT(P=0.97).CONCLUSIONS:Moderntreatmenttechniquesincludinguseofconcurrenttemozolmide,limitedCTVmarginsize,andIMRThavenotgreatlychangedthepatternsoffailureofGBM.

简介：Objective:Toassesstheimpactofpastlivermetastasesonthesurvivaldurationofpatientswhoareundergoingsurgeryforlungmetastases.Methods:Weconductedareviewofliteraturepublishedfrom2007to2014.ThestudieswereidentifiedbysearchingPubMed,MEDLINE,andEmbaseandweresupplementedbyamanualsearchofthereferenceslistedbytheretrievedstudies.Thefollowingsearchtermswereused:lungmetastasectomy,pulmonarymetastasectomy,lungmetastases,andlungmetastasis.Weselectedretrospectiveandprospectivestudiespublishedfrom2007to2014onpatientswithlungmetastasesfromcolorectalcancerandwereundergoingsurgerywithcurativeintent.Weexcludedreviews,studiesthatfocusedonsurgicaltechniques,patientswhoweretreatednon-surgically,analysesofspecificsubgroupsofpatients,andthosethatdidnotreportfollow-upofthepatientsundergoingsurgery.Results:Weidentified28papersthatassessedsurvivalafterlungmetastases,21ofwhichweremostlyretrospectivestudiesthatidentifiedpreviouslivermetastasestoexploretheirimpactonpatientsurvival.Inmorethanhalfofthepapersanalyzed(63.2%),patientswithahistoryofresectedlivermetastaseshadalowersurvivalratethanthosewhodidnothavesuchahistory,andthedifferencewasstatisticallysignificantineightofthesestudies.However,datawerepresenteddifferently,andauthorsreportedmeansurvivaltime,survivalrates,orhazardratios.Conclusions:Ahistoryoflivermetastasesseemstobeanegativeprognosticfactor,buttheindividualdataneedtoundergoameta-analysis.