No abstract

Background & purpose: Prophylactic cranial irradiation (PCI) is recommended for limited-stage small-cell lung cancer (LS-SCLC) patients with good response to concurrent chemoradiation. We report our institution's 20-year experience with this patient population and associated clinical outcomes. Materials & methods: A retrospective cohort of consecutive LS-SCLC patients treated with curative intent chemoradiation at our institution was reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method, and significant covariates determined by the Cox proportional hazards model. Covariates predictive of PCI were determined using Fisher's exact test and the Mann-Whitney test. Brain failure risk (BFR) was calculated using the cumulative incidence method treating death as a competing event. Treatment cohorts (historic vs. contemporary) were stratified by the median year of diagnosis (2005). Results: A total of 369 patients with LS-SCLC were identified, of which 278 patients were notionally PCI eligible. PCI was given to 196 patients (71%). Younger age was associated with PCI utilization (p < 0.001). PCI utilization rates did not change between the historic and contemporary treatment era (p = 0.11), whereas magnetic resonance imaging (MRI) use at baseline and follow-up became more prevalent in the contemporary era (p = <0.001). On multivariable analysis, PCI utilization was associated with improved OS (HR 1.88, 95% CI 1.32-2.69) and decreased BFR (HR 4.66,. Patients who had MRI follow-up had a higher incidence of BFR (HR 0.35, 95% CI 0.18-0.66) in multivariable analyses. Conclusions: For LS-SCLC patients at our institution, PCI is more frequently utilized in younger patients, and the utilization rate did not change significantly over the past 20 years. PCI was independently associated with improved OS and lower BFR. Omission of PCI in LS-SCLC patients should not be routinely practiced in the absence of further prospective data.

Cerebral concussion is a brain injury, that involves a complex pathophysiological process that affects the brain as a result of biomechanical forces. With the increasing prevalence, it is important that the public is knowledgeable about concussion and its symptoms, so that they can bring attention to individuals with concussion symptoms soon after onset, for appropriate care. The aim of this study was to determine the knowledgeability of young adults. Secondary aims were to compare the knowledgeability of young adults of different age, of different countries of residence, of different sex, and of different perceived knowledge about concussions. An online survey was circulated to young adults in Canada, the US and the UK. The survey consisted of three components – a consent form, respondent demographics and eight questions to assess each respondent’s knowledgeability of concussions. The knowledgeability of each respondent was determined by the summation of the number of correct responses to the knowledge questions. A total of 307 respondents consented and completed the survey in its entirety. The mean knowledge score was 4.25 out of 8. None of the cohort analyses based on demographics – 19 years old and under vs. 20 years and older; North Americans vs. non-North Americans; females vs. males – suggested that one group was more knowledgeable than the other group. These results suggest that educational programs can be developed to increase awareness of concussions. As each cohort seems to have similar starting knowledge levels, it seems appropriate to develop a uniform program to first try to increase knowledgeability, and then produce specialised programs to raise knowledge of certain cohorts. However, prior to the establishment of programs, further studies should be conducted to verify the results disclosed herein.

No abstract