Zachary Hopkins

Comparison of external beam radiation and brachytherapy to external beam radiation alone for unresectable extrahepatic cholangiocarcinoma

BACKGROUND Extrahepatic cholangiocarcinoma (EHC) is a rare malignancy with a relatively poor prognosis. There are no randomized, prospective data to help define the optimal method of radiation delivery for unresectable EHC. The purpose of this study was to evaluate the benefit of adding brachytherapy to external beam radiation therapy (EBRT) for unresectable EHC. METHODS A retrospective review of 1,326 patients with unresectable EHC using the Surveillance, Epidemiology, and End Results (SEER) database was completed. Kaplan-Meier methods were used to analyze the primary endpoint, overall survival. Univariate and multivariate analysis was performed to identify and control for potential confounding variables, including age at diagnosis, sex, stage, grade, histology, race, year of diagnosis, and reason for no surgery. RESULTS Of the 1,326 patients with unresectable EHC, 1,188 (92.9%) received EBRT only, while 91 (7.1%) received both EBRT and brachytherapy. Patients receiving combined modality radiation therapy were more likely to be treated prior to the year 2000. Median overall survival for patients receiving EBRT and EBRT plus brachytherapy was 9 and 11 months, respectively (P=0.04). Cause specific survival was 12 months for those receiving EBRT only, and 15 months for those who received EBRT + brachytherapy (P=0.10). Survival analysis performed on patients with locoregional disease only revealed a trend towards prolonged overall survival with those receiving EBRT + brachytherapy (P=0.08). Multivariate analysis revealed grade and stage of disease were correlated with both overall survival and cause specific survival (P≤0.05). CONCLUSIONS Among patients with unresectable EHC, the addition of brachytherapy to EBRT is associated with a prolonged median overall survival. However, the use of brachytherapy boost decreased in the last decade of the study.

An international comparison of Google searches for sunscreen, sunburn, skin cancer, and melanoma: Current trends and public health implications

Google Trends® (GT) offers insight into public interests and behaviors and holds potential for guiding public health campaigns.

Pure testicular choriocarcinoma presenting as a friable hemorrhagic nodule on the lip

Here we present a case of metastatic cutaneous choriocarcinoma presenting as a lesion on the upper lip. This report briefly discusses choriocarcinoma, cutaneous manifestations, and prognosis.

Acute localized exanthematous pustulosis (ALEP) caused by lamotrigine

A case of facial acute localized exanthematous pustulosis (ALEP) secondary to lamotrigine is presented. Upon rechallenge with the culprit medication, the patient had acute generalized exanthematous pustulosis (AGEP). This case highlights lamotrigine as a novel causative agent for this type of drug rash, and the unique progression from ALEP to AGEP upon rechallenge.

Lack of confidence interval reporting in dermatology: a call to action

Confidence intervals (CIs) offer a complete and intuitive presentation of results and are more informative than P‐values. The current prevalence of CI reporting in the dermatology literature has not been discussed.

Local and Locoregional Disease Free Survival in Patients Receiving NSM or SSM Compared with Conventional Mastectomy

Introduction: In this study we evaluated local recurrence-free survival (LRFS) and locoregional recurrence-free survival (LRRFS) for women at our institution who received NSM and SSM as compared to patients receiving traditional non-skin or nipple sparing mastectomies (TM). Methods: From 2005 to 2014, women with T1-2, N0, M0 disease who did not receive radiation were included in the analysis. Patients were separated into one of three cohorts based on mastectomy type. Kaplan Meier survival estimates were used to estimate LRFS and LRRFS. Cox proportional hazards analysis was used to calculate risk factors contributing to these outcomes. Results: At eight years, LRFS was 95.9% for TM, 100.0% for NSM and 96.8% for SSM. Log-rank analysis showed no significant difference in LRFS between the 3 groups (p = 0.67). At eight years LRRFS was 94.3% for TM, 92.6% for NSM and 91.4% for SSM with no significant differences seen among these groups (p = 0.51). In univariate analyses, only T-stage was a significant risk factor for local recurrence (HR 3.84, 95% CI 1.17 12.6, p = 0.03). Conclusions: For this patient population, SSM and NSM appear to be safe and equivalent to TM at 8 years of follow up.