Non-small-cell lung cancer (NSCLC) patients who experience brain metastases are usually associated with poor prognostic outcomes. This retrospective study proposed to assess whether bevacizumab or gefitinib can be used to improve the effectiveness of whole brain radiotherapy (WBRT) in managing patients with brain metastases. A total of 218 NSCLC patients with multiple brain metastases were retrospectively included in this study and were randomly allocated to bevacizumab-gefitinib-WBRT group (n=76), gefitinib-WBRT group (n=77) and WBRT group (n=75). Then, tumor responses were evaluated every 2 months based on Response Evaluation Criteria in Solid Tumors version 1.0. Karnofsky performance status and neurologic examination were documented every 6 months after the treatment. Compared to the standard WBRT, bevacizumab and gefitinib could significantly enhance response rate (RR) and disease control rate (DCR) of WBRT (P<0.001). At the same time, RR and DCR of patients who received bevacizumab-gefitinib-WBRT were higher than those who received gefitinib-WBRT. The overall survival (OS) rates and progression-free survival (PFS) rates also differed significantly among the bevacizumab-gefitinib-WBRT (48.6 and 29.8%), gefitinib-WBRT (36.7 and 29.6%) and WBRT (9.8 and 14.6%) groups (P<0.05). Although bevacizumab-gefitinib-WBRT was slightly more toxic than gefitinib-WBRT, the toxicity was tolerable. As suggested by prolonged PFS and OS status, bevacizumab substantially improved the overall efficacy of WBRT in the management of patients with NSCLC.

Editor-The successful hip arthroplasty (HA) can greatly relieve pain and improve the quality of postoperative life, in patients suffering severe hip diseases including osteoarthritis or fracture. 1 2 However, patient-and surgery-related factors have been linked to a decrease in the quality of life, both perioperatively and later. 3 4 Age, anaesthesia, hypoxaemia, hypotension and anaemia appear to be associated with the development of postoperative outcomes, including delirium in geriatric patients after orthopaedic surgery. 5 6 Surprisingly, few studies have tested the associations between anaesthesia, chronic hypoxaemia, high altitude, patient age, perioperative management and serious adverse events (SAEs) during hip arthroplasty. In view of the above and increasing international recognition that perioperative management demanding a multidisciplinary approach 3 7 does affect patient outcome, we designed a multidisciplinary perioperative management plan for primary hip replacement.Firstly, we retrospectively explored cases of primary HA and then conducted regression analyses to identify outcome risk factors. We found the intraoperative hypotension and general anaesthesia were the independent risk factors for postoperative serious adverse events (SAEs, including ICU admission, malignant arrhythmia, delirium, etc.) with odds ratio (OR) 4.29 and 95% confidence interval (CI) (1.66-11.10), and OR 5.09 with 95% CI (1.96-13.24) respectively. And we conclude that intraoperative hypotension (a mean arterial pressure that was decreased by 30% for more than 3 min) were risk markers of postoperative SAEs in high altitude practice.Secondly, we conducted a multidisciplinary management implementation in patients with moderate to severe hypoxaemia. Then the subsequent patients were shared with shorter postoperative length of stay, of which the median were decreased from 15 days to 11 after implementation (P < 0.001). The perioperative SAE ratios decreased from 21.1% (32/152) initially to 9.4% (18/192) after modification (P ¼ 0.002). The all-cause mortality rate within 30 days decreased by 80% (P ¼ 0.040).A systematic approach optimized to achieve stable haemodynamics with combined-spinal epidural anaesthesia (the most popular method in HA in this hospital) was associated with improved outcome up to 30 days after operation. We must now postulate that a randomized trial is necessary to determine if the multidisciplinary management programme can improve patient outcomes, additional to just measures of hypotension or method of anaesthesia. However, high-quality prospective studies are required to confirm these findings and to establish evidencebased clinical guidelines. Declaration of interestNone declared.