We identify cancer patients at highest risk of fatal stroke. This is a population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1992-2015. Among 7,529,481 cancer patients, 80,513 died of fatal stroke (with 262,461 person-years at risk); the rate of fatal stroke was 21.64 per 100,000-person years, and the standardized mortality ratio (SMR) of fatal stroke was 2.17 (95% CI, 2.15, 2.19). Patients with cancer of the prostate, breast, and colorectum contribute to the plurality of cancer patients dying of fatal stroke. Brain and gastrointestinal cancer patients had the highest SMRs (>2-5) through the follow up period. Among those diagnosed at <40 years of age, the plurality of strokes occurs in patients treated for brain tumors and lymphomas; if >40, from cancers of the prostate, breast, and colorectum. For almost all cancers survivors, the risk of stroke increases with time.

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MiRNAs have been shown to play key roles in both the function and differentiation of a number of different cell types. Drosha and Dicer, two RNAase III enzymes, function in a stepwise manner to generate a mature miRNA. Previous studies have demonstrated that podocyte-specific deletion of Dicer during development results in a collapsing glomerulopathy (CG). However these studies did not address whether miRNAs are required for the normal function of a mature podocytes throughout life. In addition, Dicer has functions other than generation of miRNAs. We now show that a podocyte-specific deletion of Drosha results in a similar phenotype to Dicer mutants confirming that the Dicer mutant phenotype is due to the loss of miRNAs. Moreover, we demonstrate that inducible deletion of Drosha in 2–3 month old mice results in a CG, thereby demonstrating for the first time that miRNAs are required for the normal function of mature podocytes. The finding that loss of miRNAs in mature podocytes leads to a CG is consistent with the idea that changes in specific miRNAs in the various podocytopathies may directly mediate disease, and suggests that identifying these miRNAs will provide new insight into disease pathogenesis and novel therapeutic targets.

The oligometastatic paradigm postulates that patients with a limited number of metastases can be treated with ablative local therapy to each site of disease with curative intent. Stereotactic ablative radiotherapy (SABR) is a radiation technique that has become widely used in this setting. However, prospective data are limited and are mainly from single institutional studies.OBJECTIVE To conduct a meta-analysis to characterize the safety and clinical benefit of SABR in oligometastatic cancer.DATA SOURCES A comprehensive search was conducted in PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cumulative Index to Nursing and Allied Health Literature on December 23, 2019, that included prospective clinical trials and review articles that were published within the past 15 years.STUDY SELECTION Inclusion criteria were single-arm or multiarm prospective trials including patients with oligometastatic cancer (ie, Յ5 sites of extracranial disease), and SABR was administered in less than or equal to 8 fractions with greater than or equal to 5 Gy/fraction. DATA EXTRACTION AND SYNTHESISThe Population, Intervention, Control, Outcomes and Study Design; Preferred Reporting Items for Systematic Reviews and Meta-analyses; and Meta-analysis of Observational Studies in Epidemiology methods were used to identify eligible studies. Study eligibility and data extraction were reviewed by 3 authors independently. Random-effects meta-analyses using the Knapp-Hartung correction, arcsine transformation, and restricted maximum likelihood method were conducted.MAIN OUTCOMES AND MEASURES Safety (acute and late grade 3-5 toxic effects) and clinical benefit (1-year local control, 1-year overall survival, and 1-year progression-free survival).RESULTS Twenty-one studies comprising 943 patients and 1290 oligometastases were included. Median age was 63.8 years (interquartile range, 59.6-66.1 years) and median follow-up was 16.9 months (interquartile range, 13.7-24.5 months). The most common primary sites were prostate (22.9%), colorectal (16.6%), breast (13.1%), and lung (12.8%). The estimate for acute grade 3 to 5 toxic effect rates under the random-effects models was 1.

This cross-sectional population-based study characterizes the epidemiology of cancer in US adolescents and young adults aged 15 to 39 years with respect to (1) patient demographic characteristics, (2) cancer type frequencies, and (3) cancer incidence trends over time.