Patrick Clemens

To evaluate the patterns of care for chemoradiation for squamous cell carcinoma (SCC) of the esophagus in Austria. An anonymous questionnaire (57 items) wa

Accurate dose computation in radiotherapy is critical due to the complexity of modern treatment modalities. Beam base data (BBD) underpin the precision of dose calculations in techniques such as Volumetric Modulated Arc Therapy (VMAT), Intensity-Modulated Radiation Therapy (IMRT), Stereotactic Radiosurgery (SRS), and Stereotactic Body Radiation Therapy (SBRT). Even minor discrepancies in BBD can compromise the accuracy of dose computations, necessitating quality assurance (QA). This study investigates the application of Monte Carlo (MC) simulations, considered the ‘gold standard’ in dose calculations, for BBD QA using SciMoCa. SciMoCa is a Monte Carlo dose engine which shares its concepts with the VMC family of codes. A total of 87 BBD sets, from 39 datasets, representing diverse linacs, were analyzed, provided by the vendor of the MC-system. Systematic errors (e.g., dose, point dose, spectrum, output errors) were categorized into error classes: severe (Type 1), moderate (Type 2), minor (Type 3). Measurements were conducted using ionization chambers and diodes, and results were compared to MC simulations. The virtual source model was tested against measurements as a proof of concept, showing an overall deviation of less than 1%, with output factors differing by less than 0.3%. The analysis of the 87 BBD sets presented that 86% of BBD sets passed the criterions of Type 1 errors, 60% for Type 2 and 28% for Type 3 criteria. In absolute terms, 24 of the 87 BBD sets met the minimum criteria and would not compromise dose calculation in TPS. The study highlights the potential of MC simulations in establishing a standardized approach to BBD QA. This approach allows for robust validation of BBD quality and self-consistency, achieving typical precision within ±0.5%. In more challenging cases, the precision may expand to ±1.0%.

Background/Objectives: Opinions concerning the role of obesity and changes in muscle mass in individuals with malignancies vary. It is believed that decreased fat tissue leads to a higher complication rate, while decreased muscle mass results in a poorer oncologic outcome. This study aimed to evaluate the impact of fat distribution and skeletal muscle mass on postoperative morbidity and long-term oncological outcomes in patients with non-metastatic colon cancer. Methods: Between 2012 and 2018, a total of 129 patients with stage I-III colon cancer were evaluated. Abdominal CT scans were used to assess muscle mass and fat tissue (subcutaneous and visceral). Differences in postoperative morbidity and long-term oncologic outcome were analyzed and compared. Results: No significant differences occurred concerning complication rate or anastomotic leakage. Individuals with altered body composition parameters had a shorter length of hospital stay (p = 0.046) and an increased duration of surgery (p = 0.029). In patients with an ASA III score, altered fat tissue distribution was associated with improvements in both overall and disease-free survival (p = 0.031 and p = 0.027, respectively) but also resulted in longer hospital stay. Conclusions: Changes in body composition parameters lead to alterations in economic factors as well as changes in oncologic survival, especially in patients with higher ASA scores. No differences in morbidity were observed.

REVIEW OF "MUSIC THERAPY FOR ALLEVIATING PAIN AND ENHANCING QUALITY OF LIFE DURING ENDODONTIC TREATMENT IN LAGOS, NIGERIA" INTRODUCTION This study investigated the effects of music therapy on pain perception, anxiety, and oral health-related qualit...

Background: whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. Methods: in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989–1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. Results: in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49–3.41, and IRR 4.13, 95%-CI 3.53–4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59–3.52, and HR 3.90, 95%-CI 3.30–4.61, respectively). Breslow thickness and Clark’s level at time of invasive diagnosis were significantly lower in 1989–2019, but the tumor characteristics of the melanomas diagnosed during 1989–1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00–2.75 vs. the general population, HR 2.12, 95%-CI 1.25–3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. Conclusions: given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.

Background: Malnutrition and skeletal muscle waste (sarcopenia) are known as predictive factors for a poor postoperative outcome. Paradoxically, obesity seems to be associated with a survival advantage in wasting diseases such as cancer. Thus, the interpretation of body composition indices and their impact on rectal cancer therapy has become more and more complex. The aim of this study was to evaluate body composition indices in locally advanced rectal cancer patients prior to therapy and their impact on short- and long-term outcomes. Methods: Between 2008 and 2018, 96 patients were included in this study. Pre-therapeutic CT scans were used to evaluate visceral and subcutaneous fat mass, as well as muscle mass. Body composition indices were compared to body mass index, morbidity, anastomotic leakage rate, local recurrency rate, and oncological long-term outcomes. Results: Increased visceral fat (p < 0.01), subcutaneous fat (p < 0.01), and total fat mass (p = 0.001) were associated with overweight. Skeletal muscle waste (sarcopenia) (p = 0.045), age (p = 0.004), comorbidities (p < 0.01), and sarcopenic obesity (p = 0.02) were significantly associated with increased overall morbidity. The anastomotic leakage rate was significantly influenced when comorbidities were present (p = 0.006). Patients with sarcopenic obesity showed significantly worse disease-free (p = 0.04) and overall survival (p = 0.0019). The local recurrency rate was not influenced by body composition indices. Conclusion: Muscle waste, older age, and comorbidities were demonstrated as strong risk factors for increased overall morbidity. Sarcopenic obesity was associated with worse DFS and OS. This study underlines the role of nutrition and appropriate physical activity prior to therapy.

Purpose In oncology settings, music, especially music therapy (MT), is frequently used to improve patients’ quality of life, pain situation, anxiety, depression, fatigue, and comfort. However, to date, there are no prospectively collected data correlating regular standardized MT sessions during radiotherapy (RT) to physical parameters such as heart rate, blood pressure, respiratory rate, and oxygen saturation and corresponding quality of life measures using quantitative descriptive scales in oncological patients. Thus, the aim of this study was to investigate the effect of MT on the condition of radiooncology patients using these parameters. Materials and methods During this study, patients participated weekly MT sessions guided by a board-certified music therapist. Data such as pain, physical comfort, and respiratory comfort based on the visual analogue scale (VAS) were collected before and after MT sessions. Furthermore, vital signs including heart rate, blood pressure, respiratory rate, and oxygen saturation as well as RT side effects were recorded. Results A total of 57 patients (age 61 ± 11 years) were enrolled in the study. Median VAS score was significantly different before and after MT for pain: VAS 1 (interquartile range [IQR]: 0–3) vs. VAS 0 (IQR: 0–2; p < 0.001); physical comfort: VAS 7 (IQR: 6–7) vs. VAS 8 (IQR: 7–9; p < 0.001); and respiratory comfort only in the patients with pre-existing symptoms (VAS < 10 before therapy): VAS 8 (IQR: 6–8) vs. VAS 9 (IQR: 8–10; p = 0.002). Furthermore, vital signs were significantly reduced from pre-session to post-session (p > 0.001): heart rate 81 ± 14 min⁻¹ to 76 ± 13 min⁻¹ and respiratory rate from 12 ± 5 min⁻¹ to 10 ± 4 min⁻¹. RT-related side effects did not interfere with participation in MT sessions. Conclusion In our study cohort of radiooncology patients, weekly MT sessions improved defined physical parameters as well as pain, physical comfort, and respiratory comfort. Establishing MT in the routine clinical setting should be more readily considered to further improve patient outcomes.

Purpose: Sexual function is crucial for the quality of life and can be highly affected by preoperative therapy and surgery. The aim of this study was to identify potential risk factors for poor sexual function and quality of life. Methods: Female patients were asked to complete the Female Sexual Function Index (FSFI-6). Male patients were demanded to answer the International Index of Erectile Function (IIEF-5). Results: In total, 79 patients filled in the questionary, yielding a response rate of 41.57%. The proportion of women was represented by 32.91%, and the median age was 76.0 years (66.0–81.0). Sexual dysfunction appeared in 88.46% of female patients. Severe erectile dysfunction occurred in 52.83% of male patients. Univariate analysis showed female patients (OR: 0.17, 95%CI: 0.05–0.64, p = 0.01), older age (OR: 0.34, 95%CI 0.11–1.01, p = 0.05), tumor localization under 6cm from the anal verge (OR: 4.43, 95%CI: 1.44–13.67, p = 0.01) and extension of operation (APR and ISR) (OR: 0.13, 95%CI: 0.03–0.59, p = 0.01) as significant risk factors for poor outcome. Female patients (OR: 0.12, 95%CI: 0.03–0.62, p = 0.01) and tumors below 6 cm from the anal verge (OR: 4.64, 95%CI: 1.18–18.29, p = 0.03) were shown to be independent risk factors for sexual dysfunction after multimodal therapy in the multivariate analysis. Quality of life was only affected in the case of extensive surgery (p = 0.02). Conclusion: Higher Age, female sex, distal tumors and extensive surgery (APR, ISR) are revealed risk factors for SD in this study. Quality of life was only affected in the case of APR or ISR.

Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological findings compared to conventional laparoscopic surgery within the first three years after the introduction. Methods: All colorectal cancer patients from two centers that either received robotic-assisted or conventional laparoscopic surgery were included in a comparative study. A propensity-score-matched analysis was used to reduce confounding differences. Results: A laparoscopic resection (LR Group) was performed in 82 cases, and 93 patients were treated robotic-assisted surgery (RR Group). Patients’ characteristics did not differ between groups. In right-sided resections, an intracorporeal anastomosis was significantly more often performed in the RR Group (LR Group: 5 (26.31%) vs. RR Group: 10 (76.92%), p = 0.008). Operative time was shown to be significantly shorter in the LR Group (LR Group: 200 min (150–243) vs. 204 min (174–278), p = 0.045). Conversions to open surgery did occur more often in the LR Group (LR Group: 16 (19.51%) vs. RR Group: 5 (5.38%), p = 0.004). Postoperative morbidity, the number of harvested lymph nodes, quality of resection and postoperative tumor stage did not differ between groups. Conclusion: In this study, we could clearly demonstrate robotic-assisted colorectal cancer surgery as effective, feasible and safe regarding postoperative morbidity and oncological findings compared to conventional laparoscopy during the introduction of a robotic system.

Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61–18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28–2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29–1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.