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MEDICAL RADIATION THERAPIES

ABSTRACT: We assessed the clinical features and treatment outcome in immunocompetent patients of primary central nervous system lymphoma (PCNSL) by retrospective chart review from 2005–12. Overall survival was analyzed by Kaplan-Meier method. 17 patients met the study criterion (male: female = 11:6). Median age at presentation was 47 years (range 15–74 years). Presenting features included motor impairment in 8(47.06%), raised intracranial tension in 6(35.29%) and seizures in 3(17.65%) patients. Contrast enhanced MRI of brain revealed periventricular lesion, with homogenous contrast enhancement and perilesional edema. Lesions were unifocal in 8(47.06%) and multifocal in 9(52.94%) patients. Stereotactic biopsy and decompression of tumor were performed in 2(11.76%) and 7(41.18%) patients respectively whereas the remaining 8(47.06%) patients were treated on basis of radiology. Histopathology showed diffuse large B cell lymphoma (CD20 + ve) in all 9 patients. Systemic lymphoma workup was negative in all patients. Systemic chemotherapy (median 6 cycles) was given in 14(82.35%) patients. The most common regimen incorporated high dose methotrexate (3gm/m2 IV D1 q3wk) with leucovorin rescue in 12(70.59%) patients- single agent in 10 and in combination in 2 patients. Whole brain radiation (WBRT-median dose 45Gy/25fractions/5weeks) was given in 12(70.59%) patients. After a median follow-up of 21 months (mean 26.24 months), 9(52.94%) patients are in complete response, 2(11.76%) patients are alive with evidence of disease and 6(35.29%) patients expired due to disease progression. The median overall survival was noted to be 34 months (actuarial rate of overall survival at 2 and 3 years- 63.3% and 43.4% respectively). On univariate analysis (Log rank test), KPS (<70 versus ?70) was a significant predictor of overall survival (p = 0.01) whereas age, sex, extent of surgery, treatment modality and choice of chemotherapy had no significant impact upon survival. Stereotactic biopsy followed by high dose single agent methotrexate with WBRT is a reasonable treatment strategy for PCNSL in a developing nation.

SUBMITTER: Ahmed I

PROVIDER: S-EPMC3823894 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Project description:To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period.Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression.There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included "improper performance" (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), "errors in diagnosis" (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and "no medical misadventure" (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. "Improper performance" was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment.Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against radiation oncologists may help direct efforts to improve quality of care and minimize the risk of being sued.

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MEDICAL RADIATION THERAPIES

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