In a randomized controlled trial of patients with 1 to 4 brain metastases, Aoyama and colleaguesArticle assessed whether the addition of up-front whole-brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) vs SRS alone results in improved survival, tumor control, and preservation of neurologic function. The authors found that adding WBRT to SRS did not improve survival or neurologic function preservation, but intracranial relapse was more common in patients who did not receive WBRT. In an editorial, RaizerArticle discusses treatment options for patients with 1 or more brain metastases.
A number of breast cancer subtypes that differ in prognosis have been identified. In an immunohistochemical examination of tumors from a population-based, case-control study of breast cancer, Carey and colleagues found a higher prevalence of basal-like tumors and a lower prevalence of luminal A tumors among premenopausal African American patients compared with postmenopausal African American and non–African American patients. Associations of the tumor subtype with tumor characteristics, axillary node status, and breast cancer–specific survival are described.
Nursing home residents with pneumonia are often transferred to the hospital, which is associated with substantial cost, complications, and reductions in quality of life. In a randomized trial, Loeb and colleagues investigated whether a clinical pathway for nursing home treatment of pneumonia and other lower respiratory tract infections could reduce hospitalizations, related complications, and costs compared with usual care. The authors found that compared with residents randomly assigned to usual care, those who were assigned to treatment according to the clinical pathway had comparable clinical outcomes, a lower likelihood of hospitalization, and lower health care costs.
In the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial, patients who were randomly assigned to early revascularization had significantly higher survival at 1 year compared with patients who had initial medical stabilization and no revascularization or late in-hospital revascularization. Hochman and colleagues, writing for the SHOCK investigators, report results of the trial involving 302 patients who were followed up for a median of 6 years. The investigators found that nearly two thirds of patients who were treated with early revascularization and survived to hospital discharge were alive. Early revascularization was associated with a 13.2% absolute and a 67% relative improvement in 6-year survival vs initial medical stabilization.
Treatment options for metastatic renal cell carcinoma (RCC) are limited. Sunitinib, an oral multitargeted tyrosine kinase inhibitor, demonstrated some antitumor effect in an early study. In an open-label trial, Motzer and colleaguesArticle investigated the efficacy of sunitinib as a second-line treatment in 106 patients with metastatic clear-cell RCC. The authors report that 36 patients had an objective response (complete and partial) and the median progression-free survival was 8.3 months. In an editorial, PascheArticle discusses RCC and the benefits and risks of sunitinib.
“With few exceptions, no matter what life has dealt us, and what stage we are in, we have the capacity to create and the ability to learn. And if these things lie fallow, so do we.” From “The Spirit of Writing.”
Desertification, the degradation of previously productive dry lands, is putting nearly 2 billion individuals around the world at risk of malnutrition and disease.
Mrs V is an 81-year-old woman who, 7 days before seeking medical care, developed an atypical headache, scalp tenderness, and jaw pain. Shmerling discusses the diagnosis, treatment, and prognosis of temporal arteritis.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about cardiogenic shock.
This Week in JAMA . JAMA. 2006;295(21):2445. doi:10.1001/jama.295.21.2445