Search

Aim: To assess the improvements during patient follow-up after implementing a proactive plan for retrieval of inferior vena cava (IVC) filters.Materials and Methods: A retrospective study was undertaken including all patients who had a temporary IVC filter inserted over a 10-year period. Patient demographics, insertion dates, retrieval dates, retrieval rates, and complications were recorded. Patients were categorised into three groups as follows: group A, no intervention where retrieval was not suggested; group B, passive intervention where retrieval was suggested but no appointment made; and group C, proactive intervention where a retrieval date was booked by the radiologist.Results: Five hundred and nine patients had a temporary IVC filter inserted at Royal Liverpool University Hospital over the study period. One per cent of patients in group C were lost to follow-up compared to 41% and 29% in groups A and B respectively (p<0.001). The number of patients who had an IVC retrieval attempt also increased to 80% in group C compared to 53% and 64% in groups A and B (p<0.001).Conclusion: Incorporation of a proactive retrieval booking system has significantly reduced the number of patients lost to follow-up to 1%, leading to an increased number of IVC filter retrieval attempts. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): The role of adjuvant radiotherapy (RT) following gross total resection (GTR) in atypical meningioma (AM) is not well established. Non-randomized prospective trials, such as RTOG 0539, suggest to treat this group with adjuvant RT. However, it remains unclear if there is any improvement in progression free survival (PFS) and overall survival (OS) with this approach. We aim to evaluate the survival benefit of adjuvant RT in AM following GTR.Materials/methods: We performed a systematic review and meta-analysis to aggregate the clinical outcomes of patients with AM who had undergone GTR, treated with and without adjuvant RT. We searched biomedical databases, such as Medline, EMBASE and CENTRAL, for studies published between January 1964 and February 2021. Both prospective and retrospective studies which reported the primary outcomes of 5-year PFS and 5-year OS were included. Extracted data was analyzed using random-effects meta-analysis of time to event using the DerSimonian and Laird methods.Results: Thirteen studies, involving 1124 patients, were included in our meta-analysis. 832 (74.0%) patients were treated with GTR alone and 302 (26.9%) patients had GTR followed by adjuvant RT. Adjuvant RT was delivered as external beam RT (3D conformal RT, intensity modulated RT, fractionated stereotactic radiotherapy) in 10 (76.9%) studies. Three (23.1%) studies also included patients treated with stereotactic radiosurgery in addition to fractionated RT. Median RT dose was 59.4 Gy. Adjuvant RT resulted in an increase of 3.9 months for restricted mean PFS truncated at 60 months (95% confidence interval (CI) 0.23-7.72; P = 0.037) and a non-statistically significant 22% reduction in the hazard of disease progression or death (hazards ratio 0.78; 95% CI 0.46-1.33; P = 0.370). Restricted mean OS, truncated at 60 months, was improved with adjuvant RT by 1.1 months (95% CI 0.37-1.81; P = 0.003) and a non-significant 21% reduction in the hazard of death from any cause (HR 0.79; 95% CI 0.51-1.24; P = 0.310).Conclusion: The use of adjuvant RT in patients with AM who have undergone GTR improved restricted mean PFS and OS. While we await the results from ongoing randomized controlled trials, adjuvant RT should be recommended.Author Disclosure: C. Wujanto: None. Y. Soon: None. T.Y. Chan: None. B. Vellayappan: None. [ABSTRACT FROM AUTHOR]