1,498 research outputs found
Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer
No full textThe aim of this study was to investigate the worldwide evidence of the roles of adjuvant chemoradiation and adjuvant chemotherapy on survival in potentially curative resected pancreatic cancer. Five randomised controlled trials of adjuvant treatment in patients with histologically proven pancreatic ductal adenocarcinoma were identified, of which the four most recent trials provided individual patient data (875 patients). This meta-analysis includes previously unpublished follow-up data on 261 patients. The pooled estimate of the hazard ratio (HR) indicated a 25% significant reduction in the risk of death with chemotherapy (H = 0.75, 95% confidence interval (CI): 0.64, 0.90, P-values(stratified) (Pstrat) = 0.001) with median survival estimated at 19.0 (95% CI: 16.4, 21.1) months with chemotherapy and 13.5 (95% CI: 12.2, 15.8) without. The 2- and 5-year survival rates were estimated at 38 and 19%, respectively, with chemotherapy and 28 and 12% without. The pooled estimate of the HR indicated no significant difference in the risk of death with chemoradiation (HR = 1.09, 95% CI: 0.89, 1.32, Pstrat = 0.43) with median survivals estimated at 15.8 (95% CI: 13.9, 18.1) months with chemoradiation and 15.2 (95% CI: 13.1, 18.2) without. The 2- and 5-year survival rates were estimated at 30 and 12%, respectively, with chemoradiation and 34 and 17% without. Subgroup analyses estimated that chemoradiation was more effective and chemotherapy less effective in patients with positive resection margins. These results show that chemotherapy is effective adjuvant treatment in pancreatic cancer but not chemoradiation. Further studies with chemoradiation are warranted in patients with positive resection margins, as chemotherapy appeared relatively ineffective in this patient subgroup
Statistical Modelling for the Prognostic Classification of Patients with Pancreatic Cancer for Optimisation of Treatment Allocation [PhD Thesis]
No full textPancreatic cancer is a common cause of cancer death and is difficult to diagnose and treat. A prognostic index is a tool that can be used in clinical practice to predict survival. Thirty six prognostic factor studies were identified but the size and statistical methods were inappropriate. Valid statistical analyses are essential to make best use of data and optimise clinical application. Continuous variables are often simplified incorrectly by i) assuming linear relationships between predictors and log-hazard or ii) using dichotomisation. Non-linearity is addressed for the first time in this disease site using restricted cubic spline and fractional polynomial functions, ideal for smooth curved relationships. Multivariable models containing non-linear transformations gave a substantially better fit. Important effects of some covariates were unrecognised under simplistic assumptions. The fitted functions generated by the two methods were similar. A direct comparison of these strategies was based on a novel approach assessing the difference in the AIC values by calculating a sampling distribution in multiple bootstrap resamples. Model validation is also addressed for the first time in this disease and suggested minimal over-fitting with reproducible prognostic information when fitted to external data. This thesis provides the first validated prognostic tool in advanced pancreatic cancer developed using appropriate statistical methodology. Four risk-sets identified by the model could help clinicians target treatments to patients more appropriately and have an impact on future trial design and analysis
Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial
No full textThe influence of type of surgery and occurrence of post-operative complications on survival following adjuvant therapy for pancreatic cancer are uncertain. Methods: Cox proportional hazard modelling was used to investigate the influence of type of surgery and the presence of complications on survival in conjunction with clinico-pathological variables in the 550 patients of the ESPAC-1 adjuvant randomized controlled trial. Results: Standard Kausch-Whipple (KW) was performed in 282 (54%) patients, 186 (35%) had a pylorus-preserving (PP) KW, 39 (7%) had a distal pancreatectomy and 21 (4%) had a total pancreatectomy. Post-operative complications were reported in 140 (27%) patients. PP-KW patients survived longer with a median (95% CI) survival of 19.9 (17.3, 23.1) months compared to 14.8 (13.0, 16.7) for KW patients (χ2LR = 15.1, p < 0.001). KW patients were more likely however to have R1 margins (67 (24%) vs. 29 (16%), χ2 = 4.59, p = 0.032), poorly differentiated tumours (70 (26%) vs. 19 (10%), χ2 = 18.65, p < 0.001) and positive lymph nodes (165 (60%) vs. 81 (44%), χ2 = 11.32, p < 0.001). Post-operative complications did not significantly affect survival. Independent prognostic factors were tumour grade, nodal status and tumour size but not type of surgery or post-operative complications. There was a survival benefit for chemotherapy irrespective of the type of surgery or post-operative complications. Conclusions: The KW and PP-KW procedures did not significantly influence the hazard of death in the presence of tumour staging, demonstrating that ESPAC-1 surgeons showed good judgement in their choice of operation. Post-operative complications did not adversely affect the survival benefit from adjuvant chemotherapy
DD-Pose: A large-scale Driver Head Pose Benchmark
No full textWe introduce DD-Pose, the Daimler TU Delft Driver Head Pose Benchmark, a large-scale and diverse benchmark for image-based head pose estimation and driver analysis. It contains 330k measurements from multiple cameras acquired by an in-car setup during naturalistic drives. Large out-of-plane head rotations and occlusions are induced by complex driving scenarios, such as parking and driver-pedestrian interactions. Precise head pose annotations are obtained by a motion capture sensor and a novel calibration device. A high resolution stereo driver camera is supplemented by a camera capturing the driver cabin. Together with steering wheel and vehicle motion information, DD-Pose paves the way for holistic driver analysis. Our experiments show that the new dataset offers a broad distribution of head poses, comprising an order of magnitude more samples of rare poses than a comparable dataset. By an analysis of a state-of-the-art head pose estimation method, we demonstrate the challenges offered by the benchmark. The dataset and evaluation code are made freely available to academic and non-profit institutions for non-commercial benchmarking purposes
Developmental Disorders (DD) and Fibromyalgia (FM), we might be able to develop both treatments at once!?
No full textThis was written when the author was 2nd year undergraduate student in Kyushu University. In this paper, I explain following 3 topics: ①Development Disorders (DD), are one of physical disabilities ②study of pain (brain, neuron, and fibromyalgia (FM)) ③ DD and FM, we might be able to develop both treatments at once!
Developmental Disorders (DD) and Fibromyalgia (FM), we might be able to develop both treatments at once!?
No full textThis was written when the author was 2nd year undergraduate student in Kyushu University. In this paper, I explain following 3 topics: ①Development Disorders (DD), are one of physical disabilities ②study of pain (brain, neuron, and fibromyalgia (FM)) ③ DD and FM, we might be able to develop both treatments at once!
Developmental Disorders (DD) and Fibromyalgia (FM), we might be able to develop both treatments at once!?
No full textThis was written when the author was 2nd year undergraduate student in Kyushu University. In this paper, I explain following 3 topics: ①Development Disorders (DD), are one of physical disabilities ②study of pain (brain, neuron, and fibromyalgia (FM)) ③ DD and FM, we might be able to develop both treatments at once!
Adjuvant therapy in pancreatic cancer: historical and current perspectives
No full textThe results from pancreatic ductal adenocarcinoma appear to be improving with increased resection rates and reduced postoperative mortality reported by specialist pancreatic cancer teams. Developments with medical oncological treatments have been difficult, however, due to the fundamentally aggressive biological nature of pancreatic cancer and its resistance to chemotherapy coupled with a relative dearth of randomised controlled trials. The European Study Group for Pancreatic Cancer (ESPAC)-1 trial recruited nearly 600 patients and is the largest trial in pancreatic cancer. The results demonstrated that the current best adjuvant treatment is chemotherapy using bolus 5-fluorouracil with folinic acid. The median survival of patients randomly assigned to chemoradiotherapy was 15.5 months and is comparable with many other studies, but the median survival in the chemotherapy arm was 19.7 months and is as good or superior to multimodality treatments including intra-operative radiotherapy, adjuvant chemoradiotherapy and neo-adjuvant therapies. The use of adjuvant 5-fluorouracil with folinic acid may be supplanted by gemcitabine but requires confirmation by ongoing clinical trials, notably ESPAC-3, which plans to recruit 990 patients from Europe, Canada and Australasia. Major trials such as ESPAC-1 and ESPAC-3 have set new standards for the development of adjuvant treatment and it is now clear that such treatment in this field has the potential to significantly improve both patient survival and quality of life after curative resection
Evidence for B-0 -> D+D- and observation of B-->(DD-)-D-0 and B-->(DD*-)-D-0 decays
No full textWe report evidence for B-0 -> D+D- and the first observation of the decay modes B-->(DD-)-D-0 and B-->(DD*-)-D-0 based on a sample of 152x10(6) B (B) over bar events collected by the Belle detector at KEKB. The branching fractions for B-0 -> D+D-, B-->(DD-)-D-0, and B-->(DD*-)-D-0 are found to be (1.91 +/- 0.51 +/- 0.30)x10(-4), (4.83 +/- 0.78 +/- 0.58)x10(-4), and (4.57 +/- 0.71 +/- 0.56)x10(-4), respectively. Charge asymmetries in the B-->(DD-)-D-0 and B-->(DD*-)-D-0 channels are consistent with zero
Current Oncological Treatment of Patients with Pancreatic Cancer in Germany: Results from a National Survey on behalf of the Arbeitsgemeinschaft Internistische Onkologie and the Chirurgische Arbeitsgemeinschaft Onkologie of the Germany Cancer Society
No full textBackground: No data have previously been available regarding the current treatment of patients with pancreatic cancer (PC) in German hospitals and medical practices. Methods: Between February 2007 and March 2008 we conducted a national survey {[}on behalf of the Arbeitsgemeinschaft Internistische Onkologie (AIO) and the Chirurgische Arbeitsgemeinschaft Onkologie (CAO)] regarding the current surgical and oncological treatment of PC in Germany. Standardized questionnaires were sent via mailing lists to members of the AIO and CAO (n = 1,130). The data were analyzed using SPSS software (version 16.0). Pre-defined subgroup analysis was performed by grouping the results of each question with regard to the professional site of the responding physician and to the number of patients treated in their institution by year. Results: 181 (16%) of the oncological questionnaires were sent back. For 61% of the participating centers, a histological confirmation of PC diagnosis is obligatory. 21% of physicians offer neoadjuvant therapy to patients with potentially resectable PC. In the adjuvant treatment after curative-intent surgery, gemcitabine (Gem) is regarded as standard of care by 71% after R0 resection and 62% after R1 resection. For patients with locally advanced PC, 52% of the participating centers recommend systemic chemotherapy, 17% prefer combined primary chemoradiotherapy. Most centers (59%) base their decision of combination regimens for metastatic disease on the performance status of their patients. In patients with a good status, 28% apply single-agent Gem, 3% use Gem + capecitabine, 12% Gem + erlotinib, 16% Gem + oxaliplatin, and 8% Gem + cisplatin. Only 28% of the survey doctors offer second-line treatment to the majority of their patients with advanced PC. Conclusion: Not every PC patient in Germany is treated according to the present S3 guidelines. Diagnosis and treatment of PC in Germany still need to be improved. Copyright (C) 2009 S. Karger AG, Base
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