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Objectives Botulinum neurotoxin (Bo NT) injections in the salivary glands and radiotherapy ( RT) on these glands are commonly used to alleviate severe drooling in patients with amyotrophic lateral sclerosis ( ALS). This study compares Bo NT type A with RT based on patient-rated evaluations. Materials & methods A prospective randomized controlled pilot study to compare RT ( n = 10; on the parotid and the posterior part of the submandibular glands) with Bo NT-A treatment ( n = 10; in the parotid glands only, because of the risk of increasing oropharyngeal weakness) in patients with ALS. The primary outcome was the drooling status (burden of drooling), and our secondary interests were the degree of salivation, global change of drooling after treatment, and level of satisfaction with the treatment and negative experiences. Results There were no statistically significant between-treatment differences for the drooling status after treatment. Only at twelve weeks more saliva reduction was achieved by RT ( P = 0.02). Patients treated with RT also described more transient negative experiences (like pain in mandible) directly after treatment. Subgroup analysis showed that patients with very severe dysphagia (no oral intake) were less satisfied and experienced a lower global change of drooling after treatment. Conclusions This pilot study showed no significant difference in the burden of drooling between the treatments. However, with RT more saliva reduction was achieved, including negative experiences directly after treatment, but without the risk of decreasing oropharyngeal function. In addition, patients with very severe dysphagia do not seem to benefit from either treatment. [ABSTRACT FROM AUTHOR]

Background: Axillary recurrence after negative sentinel lymph node biopsy (SLNB) in patients with invasive breast carcinoma remains a concern. Previous investigations to identify prognostic factors for axillary recurrence identified that a disproportionate number of patients with an axillary recurrence after negative SLNB were not treated with external beam radiation therapy (EBRT) of the breast as part of initial treatment. This finding prompted a systematic review to test the hypothesis that EBRT to the breast reduces the risk of axillary recurrence after negative SLNB. Methods: A literature search was performed in PubMed, the Cochrane Library and the Spanish-language database LILACS to identify articles publishing data regarding follow-up of sentinel lymph node (SLN)-negative patients. Reports and articles lacking information on the initial treatment were excluded. Results: Forty-five articles were accepted for review. A total of 23 357 SLN-negative patients were identified with median follow-up ranging from 15 to 102 months. Some 18 878 patients were treated with EBRT to the breast as part of their initial treatment. One hundred and twenty-seven patients with an axillary recurrence were identified, of whom 73 had EBRT as part of their initial treatment. Meta-analysis showed that EBRT was associated with a lower rate of axillary recurrence (P < 0.001), but this finding was subject to heterogeneity. Conclusion: This review and meta-analysis showed that EBRT is associated with a significantly lower axillary recurrence rate after negative SLNB. [ABSTRACT FROM AUTHOR]