No abstract

PURPOSE Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are presented. METHODS Women ≥ 50 years of age with low-risk invasive breast carcinoma (pT1-2 pN0) were randomly assigned to 50 Gy/25 fr (5 weeks) or 30 or 28.5 Gy in 5 fr of 6.0 or 5.7 Gy (1 week). The primary end point was change in photographic breast appearance at 2 and 5 years; secondary end points were physician assessments of NTE and local tumor control. Odds ratios (ORs) from longitudinal analyses compared regimens. RESULTS A total of 915 women were recruited from 18 UK centers (2004-2007). Five-year photographs were available for 615/862 (71%) eligible patients. ORs for change in photographic breast appearance were 1.64 (95% CI, 1.08 to 2.49; P = .019) for 30 Gy and 1.10 (95% CI, 0.70 to 1.71; P = .686) for 28.5 Gy versus 50 Gy. α/β estimate for photographic end point was 2.7 Gy (95% CI, 1.5 to 3.9 Gy), giving a 5-fr schedule of 28 Gy (95% CI, 26 to 30 Gy) estimated to be isoeffective with 50 Gy/25 fr. ORs for any moderate/marked physician-assessed breast NTE (shrinkage, induration, telangiectasia, edema) were 2.12 (95% CI, 1.55 to 2.89; P < .001) for 30 Gy and 1.22 (95% CI, 0.87 to 1.72; P = .248) for 28.5 Gy versus 50 Gy. With 9.9 years median follow-up, 11 ipsilateral breast cancer events (50 Gy: 3; 30 Gy: 4; 28.5 Gy: 4) and 96 deaths (50 Gy: 30; 30 Gy: 33; 28.5 Gy: 33) have occurred. CONCLUSION At 10 years, there was no significant difference in NTE rates after 28.5 Gy/5 fr compared with 50 Gy/25 fr, but NTE were higher after 30 Gy/5 fr. Results confirm the published 3-year findings that a once-weekly 5-fr schedule of whole-breast radiotherapy can be identified that appears to be radiobiologically comparable for NTE to a conventionally fractionated regimen.

Capillary whole-blood glucose values best approximated venous plasma glucose values from the laboratory. Measuring the venous whole-blood glucose using the glucometer resulted in an overestimation of the venous plasma glucose compared with the laboratory result by about 0.97 mmol/L (17.46 mg/dL). This may result in the withholding of intravenous glucose for patients who are actually hypoglycemic.

No abstract

BackgroundObstructive Sleep Apnoea Syndrome (OSAS) is common in morbidly obese patients. Previous studies indicate bariatric surgery reduces the severity of OSAS but may not cure it. We explored the impact bariatric surgery on patients who were commenced on CPAP prior to surgery.MethodsAll morbidly obese patients who underwent bariatric surgery at our institution, between June 2010 and May 2014 who underwent sleep study (SS) or oximetry prior to bariatric surgery were included. The primary end point was cure (oximetry off CPAP showing either ODI less than 5 or ODI 5–15 with ESS <10 and no other symptoms of SDB) from OSAS. Secondary end points were weight loss achieved, improvement in OSAS and improvement in ESS. All data were obtained from electronic bariatric surgery and sleep service databases.Results184 patients underwent bariatric surgery. 97 (52.7%) had SS or oximetry prior to surgery. (Figure 1) Mean ODI was 25 (95% CI 19–30) and ESS 12 (95% CI 10–13). Out of 46 patients considered for CPAP, 45 continued using CPAP peri-operatively, one discontinued after failed trial. 20 (43.4%) patients were considered cured from OSAS by 12–24 months. 17 (36.9%) patients became asymptomatic and returned CPAP were considered to be cured clinically but not had SS post surgery. At 12 months post bariatric surgery, there were significant (P < 0.0001) reductions in various parameters; means of difference in ODI 34, ESS 10 and BMI 17.8.Abstract P116 Figure 1Patient characteristics. ESS = Epworth Sleepiness Score, ODI = Oxygen Desaturation Index, AHI = Apnoea Hypopnoea IndexDiscussion and conclusionIn contrast to the meta-analysis (Greenburg et al. 2009) in which 62% had residual disease in our cohort 80% had clinical cure and they had a lower post-op ODI (7.1) in spite of comparable weight loss. Even though our patients had similar pre-op BMI but the mean pre-op ODI was less than most reported studies the reason for which is not clear but might be responsible for a much higher cure rate.Reference1 Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 2009;122:535–42