Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.

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Studies of the association between inappropriate antibiotic therapy and mortality among bacteremic patients have generated conflicting findings. We systematically reviewed these studies to identify methodological heterogeneity that may explain the lack of agreement. We identified 51 articles that met the inclusion criteria, and we extracted the following data: study design, definition and measurement of variables, and statistical methods. Only 8 studies (16%) defined inappropriate antibiotic therapy as that which was inactive in vitro against the isolated organism(s) and not consistent with current clinical practice recommendations and distinguished between empiric and definitive treatment. Thirty-four studies (67%) measured the severity of illness, but only 6 (12%) specified the time at which it was measured. The methodological recommendations suggested in this article are intended to improve the validity and generalizability of future research. In brief, future studies should define "inappropriate" therapy on the basis of in vitro susceptibility data, should separately evaluate empiric and definitive therapy, and should control for the baseline severity of illness.

Purpose The benefit of radiation therapy in extremity soft tissue sarcomas remains controversial. The purpose of this study was determine the effect of radiation therapy on overall survival among patients with primary soft tissue sarcomas of the extremity who underwent limb sparing surgery. Patients and Methods A retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database that included data from January 1, 1988, to December 31st, 2005. A total of 6,960 patients comprised the study population. Overall survival curves were constructed using Kaplan-Meir Method and for patients with low and high grade tumors. Hazard ratios were calculated based on multivariable Cox proportional hazards models. Results Of the cohort, 47% received radiation therapy. There was no significant difference in overall survival among patients with low grade tumors by radiation therapy. In high grade tumors, the 3 year overall survival was 73% in patients who received radiation therapy vs. 63% for those who did not receive radiation therapy (p < 0.001). On multivariate analysis, patients with high grade tumors who received radiation therapy had an improved overall survival (HR 0.67, 95% CI 0.57-0.79). In patients receiving radiation therapy, 13.5% received it in a neo-adjuvant setting. The incidence of patients receiving neo-adjuvant radiation did not change significantly between 1988 and 2005. Conclusions This is the largest population based study reported in patients undergoing limb sparing surgery for soft tissue sarcomas of the extremities and reports that radiation was associated with improved survival in patients with high grade tumors.