Showing posts with label Netherlands. Show all posts
Showing posts with label Netherlands. Show all posts
Thursday, November 24, 2011
Friday, December 24, 2010
Radiation Therapy Comparable To Surgery In Elderly Patients
Stereotactic radiation therapy produces the same survival outcomes for elderly patients diagnosed with early-stage lung cancer as surgery, according to research presented at the 2010 Chicago Multidisciplinary Symposium in Thoracic Oncology held December 9-11.
According to the study, patients who underwent stereotactic radiation therapy had a lower risk of dying within the first 30 days following treatment, even though this was a frailer group of patients compared to controls. The research was conducted by a team from Amsterdam's VU University Medical Center, the Comprehensive Cancer Center, and the Netherlands Cancer Institute.
The group conducted a matched-pair analysis of the overall survival outcomes of patients living in north Holland who received treatment after being diagnosed with stage I non-small cell lung cancer (NSCLC) between 2005 and 2007. A total of 191 patients were identified from a comprehensive population-based registry. From this group, a total of 122 patients could be matched, half of whom had surgery and half of whom had stereotactic body radiation therapy (SBRT) treatments.
The median age of the patients at the time of diagnosis was 79 years. Patients were matched by age, gender, year of treatment, and T-stage. Baseline co-morbidities were not available, but a large number of patients who received the stereotactic radiation therapy were medically inoperable, according to lead author and presenter David Palma, MD, a radiation oncologist who conducted the study while on a research fellowship at VU University Medical Center. Palma is now practicing at the London Regional Cancer Program in London, Ontario.
Patients were followed for a median of 43 months. Six patients died within the first 30 days following treatment; five of these patients had undergone surgery. Overall survival at one year was 75% for surgical patients and 87% for radiation therapy patients. Three years following treatment, 60% of the surgery group and 41% of the radiation therapy group were alive.
"Many would expect that the patients treated with radiation therapy would do worse than those undergoing surgery," Palma told attendees at the American Society for Radiation Oncology (ASTRO)-sponsored symposium.
"At the time that these patients underwent treatment, patients only received radiation if they were too unwell for surgery or if they refused surgery," he continued. "Because most of these radiation therapy patients had medical problems that prevented them from having surgery, we would expect them not to live as long as the surgery patients. Yet, despite this disadvantage, the radiation therapy patients lived just as long as the healthier patients who had surgery for the first 12 months following treatment."
Up to one-fourth of Dutch patients older than 75 who are diagnosed with stage I and stage II NSCLC do not receive any oncologic therapy, Palma said. Stereotactic body radiation therapy is an attractive treatment option for surgically unfit and/or elderly patients, due to its ease of administration and favorable toxicity profile, he explained.
"Patients prefer this treatment because there is no hospitalization associated with it, it doesn't require an anesthetic, there is no risk of infection from a surgical procedure, and it only takes a few treatments," Palma added:"I think that the use of stereotactic body radiation therapy will increase," he added. "We've seen over the past five years already that elderly patients and their physicians are choosing radiation more often to treat stage I lung cancer, and fewer patients are choosing to go without treatment as well. This study shows us that the stereotactic treatment is effective even for patients who have many medical problems."
A comparison of the costs of each treatment was not in the scope of the study. However, Palma said that cost-effectiveness studies are currently being performed, though results are not yet available. "In most countries with socialized medicine, once radiation therapy equipment has been purchased, the cost of radiation treatment is relatively inexpensive," he concluded.
By Cynthia E. Keen
AuntMinnie.com staff writer
December 17, 2010
Monday, January 4, 2010
Chasing terrorists: It's Obama's ball now
As the new year commences, two facts emerge: George W. Bushis officially retired as the fault-guy for the nation's ills, and Barack Obama owns the game.
Whether he wants to or not.
Every president deserves a year of grace to adapt to the job and adjust to its Himalayan learning curve. As Obama's first year ends -- almost with a bang, thanks to a lonely Nigerian who found love in jihad -- his grace period is up.
Indeed, depending on how he responds to the security breach that almost brought down a Detroit-bound flight from Amsterdam, Obama's presidency is at risk of being rendered prematurely impotent.
If Bush could be blamed for the dot-connecting inadequacies that helped enable the terrorist attacks of 9/11 eight months into his administration, then Obama can fairly be held responsible for the incompetence that allowed a disaffected jihadist to get explosive powder onto a plane.
The banality of our most recent would-be attack is almost too on-the-nose to exploit, but really. The son of a Nigerian banker, already a punch line to all who've been spammed by e-mailers alleging to be Nigerian bankers promising riches, packs his underwear with explosive material? Was this fellow computer-generated by a cartoon character?
If it weren't all so bloody horrifying, the incident would be ridiculous.
Which, come to think of it, is a fair appraisal of the Obama administration's initial performance when faced with a potentially catastrophic terrorist strike. The dots that needed connecting were all but performing the California Raisin dance. Were we ever justified in hoping for better?
National security was never considered Obama's strong suit. Back in September 2008, if I may be excused for quoting myself, I wrote: "I worry that Obama isn't serious enough about terrorism and free markets. . . . I worry about Obama's overintellectualizing -- that he will get lost in a maze of deep thoughts and fail to be decisive when necessary."
Or lost on a golf course, as the case may be.
Whether he wants to or not.
Every president deserves a year of grace to adapt to the job and adjust to its Himalayan learning curve. As Obama's first year ends -- almost with a bang, thanks to a lonely Nigerian who found love in jihad -- his grace period is up.
Indeed, depending on how he responds to the security breach that almost brought down a Detroit-bound flight from Amsterdam, Obama's presidency is at risk of being rendered prematurely impotent.
If Bush could be blamed for the dot-connecting inadequacies that helped enable the terrorist attacks of 9/11 eight months into his administration, then Obama can fairly be held responsible for the incompetence that allowed a disaffected jihadist to get explosive powder onto a plane.
The banality of our most recent would-be attack is almost too on-the-nose to exploit, but really. The son of a Nigerian banker, already a punch line to all who've been spammed by e-mailers alleging to be Nigerian bankers promising riches, packs his underwear with explosive material? Was this fellow computer-generated by a cartoon character?
If it weren't all so bloody horrifying, the incident would be ridiculous.
Which, come to think of it, is a fair appraisal of the Obama administration's initial performance when faced with a potentially catastrophic terrorist strike. The dots that needed connecting were all but performing the California Raisin dance. Were we ever justified in hoping for better?
National security was never considered Obama's strong suit. Back in September 2008, if I may be excused for quoting myself, I wrote: "I worry that Obama isn't serious enough about terrorism and free markets. . . . I worry about Obama's overintellectualizing -- that he will get lost in a maze of deep thoughts and fail to be decisive when necessary."
Or lost on a golf course, as the case may be.
Obama's open-collared, vacation response from Hawaii was delivered on Katrina time -- about two days too late -- and fell a few links short of reassuring. Something about humans and systems failing. Yes, well, that would about cover it.
Deep breath.
The cool detachment that was so attractive when political opponents were trying to rile Obama is suddenly becoming annoying. Preternaturally unflappable, his demeanor in these circumstances borders on inappropriate. What does it take to get a rise out of Barack Obama? Not that we need bombast and flared nostrils. Calm in the face of potential disaster is laudable, but it's a fine line between executive tranquility and passive nonchalance. Like a tone-deaf disc jockey, Obama plays elevator music when the crowd wants John Philip Sousa.
But, action is being taken, we're told. Investigations are under way and reports are being tabulated. Soon decisions will be forthcoming as to whether we bomb al-Qaida outposts in Yemen or insist that airline travelers liberate their inner Britneys and go panty-free through security checkpoints.
Full cavity searches can't be far from the minds of bureaucrats looking for ways to create a faux sense of security rather than figuring out how to draw simple inferences from red flags, recently in numbers sufficient to spell out "Allahu Akbar" on a football field at halftime.
The brightest among many was the perpetrator's own father's reports, both in person (twice) and by phone to American officials, that his son had become radicalized and might be dangerous. A CIA report describing those concerns apparently never made it through the Byzantine intelligence channels until after the foiled attack on Christmas Day.
Why? It was for just such coordination that the Bush administration four years ago created the Office of the Director of National Intelligence, which last April came under fire by its then-inspector general, Edward Maguire -- just days before he was replaced. Maguire's report may provide the simplest answer to what went wrong.
In addition to criticizing the amount of time intelligence chiefs spend briefing the White House and Congress instead of managing the intelligence apparatus, Maguire blasted the ODNI for bureaucratic fat and financial mismanagement.
In fairness to Obama, Maguire's findings were completed before the president assumed office, but not released publicly until April. Even so, Obama has had plenty of time to tweak the system he now blames for the underwear bomber.
It's his ball now; time to stop dribbling.
Deep breath.
The cool detachment that was so attractive when political opponents were trying to rile Obama is suddenly becoming annoying. Preternaturally unflappable, his demeanor in these circumstances borders on inappropriate. What does it take to get a rise out of Barack Obama? Not that we need bombast and flared nostrils. Calm in the face of potential disaster is laudable, but it's a fine line between executive tranquility and passive nonchalance. Like a tone-deaf disc jockey, Obama plays elevator music when the crowd wants John Philip Sousa.
But, action is being taken, we're told. Investigations are under way and reports are being tabulated. Soon decisions will be forthcoming as to whether we bomb al-Qaida outposts in Yemen or insist that airline travelers liberate their inner Britneys and go panty-free through security checkpoints.
Full cavity searches can't be far from the minds of bureaucrats looking for ways to create a faux sense of security rather than figuring out how to draw simple inferences from red flags, recently in numbers sufficient to spell out "Allahu Akbar" on a football field at halftime.
The brightest among many was the perpetrator's own father's reports, both in person (twice) and by phone to American officials, that his son had become radicalized and might be dangerous. A CIA report describing those concerns apparently never made it through the Byzantine intelligence channels until after the foiled attack on Christmas Day.
Why? It was for just such coordination that the Bush administration four years ago created the Office of the Director of National Intelligence, which last April came under fire by its then-inspector general, Edward Maguire -- just days before he was replaced. Maguire's report may provide the simplest answer to what went wrong.
In addition to criticizing the amount of time intelligence chiefs spend briefing the White House and Congress instead of managing the intelligence apparatus, Maguire blasted the ODNI for bureaucratic fat and financial mismanagement.
In fairness to Obama, Maguire's findings were completed before the president assumed office, but not released publicly until April. Even so, Obama has had plenty of time to tweak the system he now blames for the underwear bomber.
It's his ball now; time to stop dribbling.
Kathleen Parker @ Chicago Tribune
Friday, December 18, 2009
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