Background: High-grade glioma (HGG) is associated with a dismal prognosis despite significant advances in adjuvant therapies, including chemotherapy, immunotherapy, and radiotherapy. Extent of resection continues to be the most important independent prognosticator of survival. This underlines the significance of increasing gross total resection (GTR) rates by using adjunctive intraoperative modalities to maximize resection with minimal neurological morbidity. 5-aminolevulinic acid (5-ALA) is the only US Food and Drug Administration–approved intraoperative optical agent used for fluorescence-guided surgical resection of gliomas. Despite several studies on the impact of intra-operative 5-ALA use on the extent of HGG resection, a clear picture of how such usage affects patient survival is still unavailable. Methods: A systematic review was conducted of all relevant studies assessing the GTR rate and survival outcomes [overall survival (OS) and progression-free survival (PFS)] in HGG. A meta-analysis of eligible studies was performed to assess the influence of 5-ALA-guided resection on improving GTR, OS, and PFS. GTR was defined as >95% resection. Results: Of 23 eligible studies, 19 reporting GTR rates were included in the meta-analysis. The pooled cohort had 998 patients with HGG, including 796 with newly diagnosed cases. The pooled GTR rate among patients with 5-ALA–guided resection was 76.8% (95% confidence interval, 69.1–82.9%). A comparative subgroup analysis of 5-ALA–guided vs. conventional surgery (controlling for within-study covariates) showed a 26% higher GTR rate in the 5-ALA subgroup (odds ratio, 3.8; P < 0.001). There were 11 studies eligible for survival outcome analysis, 4 of which reported PFS. The pooled mean difference in OS and PFS was 3 and 1 months, respectively, favoring 5-ALA vs. control ( P < 0.001). Conclusions: This meta-analysis shows a significant increase in GTR rate with 5-ALA–guided surgical resection, with a higher weighted GTR rate (~76%) than the pivotal phase III study (~65%). Pooled analysis showed a small yet significant increase in survival measures associated with the use of 5-ALA. Despite the statistically significant results, the low level of evidence and heterogeneity across these studies make it difficult to conclusively report an independent association between 5-ALA use and survival outcomes in HGG. Additional randomized control studies are required to delineate the role of 5-ALA in survival outcomes in HGG.

Background Invasive-disease-free survival (IDFS) rates are excellent in breast cancer (BC) patients with hormone-receptor-positive (HR+), human-epidermal-growth-factor-receptor-2-negative (HER2−), axillary-lymph-node-negative (LN−) tumors with a 21-gene-expression assay recurrence-score (RS) of 0–10. However, outcomes among patients with a RS of 11–25 treated with endocrine therapy alone are unknown. Methods In this retrospective single-institution study, we described the characteristics of HR+, HER2−, LN− BC patients who underwent a 21-gene-expression assay. Additionally, among those diagnosed between 2005 and 2011 we measured IDFS, recurrence-free survival (RFS), distant-relapse-free survival (DRFS), and overall survival (OS) rates, focusing on patients with a RS of 11–25 by receipt of chemotherapy. We used the Kaplan-Meier method to estimate survival rates and multivariable Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Among 1,424 patients, the RS distribution was 0–10 in 297 patients (21%), 11–25 in 894 (63%), and >25 in 233 (16%); of these, 1.7%, 15%, and 73.4% received chemotherapy, respectively. With a median follow-up of 58 months, those with a RS of 11–25 had an IDFS rate (95% CI) at 5 years of 92.6% (89.6%–94.7%), which was comparable between those who received chemotherapy and those who did not. The HRs (95% CIs) of the effect of chemotherapy were: IDFS, 1.64 (0.73–3.71); RFS, 1.46 (0.41–5.23); DRFS, 1.25 (0.32–4.92); and OS, 2.19 (0.44–11.0). Conclusion Our study showed similar outcomes with or without chemotherapy in HR+, HER2−, LN− BC patients who have a RS of 11–25, but a benefit from chemotherapy in this group cannot be ruled out.

Cisplatin is a bedrock of cancer management and one of the most used chemotherapeutic agents in the treatment of germ cell, lung, bladder, ovarian, and head and neck cancers. Approximately 500,000 patients diagnosed annually with these cancer types in the United States could be candidates for treatment with cisplatin. There is a 5-fold increase in the risk of hearing impairment or ototoxicity with cisplatin, which can manifest as ringing in the ear (tinnitus), high-frequency hearing loss, and at late stages, a decreased ability to hear normal conversation. More than half of adult and pediatric patients with cancer treated with cisplatin developed hearing impairment with major impact on patients' health-related quality of life. A considerable evidence gap persists regarding the burden and effective prevention and interception strategies for cisplatin-induced ototoxicity, especially in adult patients with cancer. We conducted a review of the published literature to provide an update on the status of this important clinical challenge. We also surveyed practicing oncologists within our network of academic and community practices to gain a better understanding of how the published literature compares with real-world practice. Our review of the literature showed a lack of standardized guidelines for monitoring and treatment of cisplatin-induced ototoxicity, especially in the adult cancer patient population. Our survey of practicing oncologists mirrored the findings from the published literature with a heterogeneity of practice, which highlights the need for standardization.

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Staphylococcus pseudintermedius is a common cause of zoonotic infections in dogs and cats. Recently, there has been an increasing number of infections being reported in humans caused by this organism. We report a case of complicated urinary tract infection in an elderly patient with recent bilateral ureteral stent placement caused by this organism with associated persistent high-grade bacteraemia.