• Carcinoid Heart Disease Revealing the Burden of a Neuroendocrine Tumour: A Case Report.

  Sajeev, Dabeet

  Carcinoid heart disease (CHD) is a rare but serious complication of carcinoid syndrome (CS), typically arising in patients with metastatic neuroendocrine tumours (NETs). Prolonged exposure of the right side of the heart to vasoactive substances such as serotonin leads to progressive valvular fibrosis, predominantly affecting the tricuspid and pulmonary valves, and often culminates in right-sided heart failure. We report the case of a 67-year-old woman with a metastatic small bowel NET who developed CS and later presented with worsening exertional dyspnoea and peripheral oedema. Echocardiography demonstrated severe tricuspid regurgitation and moderate pulmonary regurgitation with preserved left ventricular systolic function. Despite aggressive diuretic therapy, her condition deteriorated, and she developed refractory right-sided heart failure with generalised anasarca. She was not a candidate for valve replacement or further disease-directed therapy due to advanced metastatic disease and frailty and was therefore managed palliatively until she passed away. This case highlights the severe burden of CHD in patients with serotonin-secreting NETs and emphasises the importance of early recognition and regular echocardiographic surveillance to facilitate timely intervention and potentially improve outcomes.
• Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

  Woodings, P

  BACKGROUND: The role of postmastectomy chest-wall irradiation in patients with breast cancer classified as pN1 (with involvement of one to three axillary nodes) or pN0 (pathologically node negative) with additional risk factors is uncertain. METHODS: In this international, phase 3, randomized trial, we evaluated the omission of chest-wall irradiation in women with "intermediate-risk" breast cancer - defined as cancer that was stage pT1N1, pT2N1, or pT3N0 or stage pT2N0 with a histologic grade of 3, lymphovascular invasion, or both (tumor size: T1, ≤2 cm; T2, >2 cm to 5 cm; or T3, >5 cm) - that was treated with mastectomy, an axillary procedure, and systemic therapy. Patients were assigned to undergo chest-wall irradiation (40 to 50 Gy; the irradiation group) or not to undergo chest-wall irradiation (the no-irradiation group). The primary end point was overall survival, with 10 years of follow-up. Chest-wall recurrence, regional recurrence, disease-free survival, distant metastasis-free survival, causes of death, and radiation-related adverse events were also assessed. RESULTS: The intention-to-treat population included 808 patients in the irradiation group and 799 in the no-irradiation group. The median follow up was 9.6 years. Overall survival was 81.4% with chest-wall irradiation and 81.9% with no chest-wall irradiation according to 10-year Kaplan-Meier estimates (hazard ratio for death, 1.04; 95% confidence interval [CI], 0.82 to 1.30; P = 0.80). A total of 29 patients had a chest-wall recurrence - 9 (1.1%) in the irradiation group and 20 (2.5%) in the no-irradiation group (between-group difference, <2 percentage points; hazard ratio, 0.45; 95% CI, 0.20 to 0.99). Disease-free survival was 76.2% in the irradiation group and 75.5% in the no-irradiation group (hazard ratio for recurrence or death, 0.97; 95% CI, 0.79 to 1.18), and distant metastasis-free survival was 78.2% and 79.2%, respectively (hazard ratio for distant metastasis or death, 1.06; 95% CI, 0.86 to 1.31). CONCLUSIONS: In this trial, chest-wall irradiation did not result in higher overall survival than no chest-wall irradiation among patients with intermediate-risk, early breast cancer treated with mastectomy and contemporary adjuvant systemic therapy. (Funded by the Medical Research Council and others; SUPREMO ISRCTN Clinical Study Registry number, 61145589.).
• Epidemiological and clinical landscape of nasopharyngeal carcinoma over two decades (2000-2021): a retrospective analysis of 10419 cases.

  Khalil, A
• Investigating the potential association between tattoos and lymphoma: an exploratory systematic review and meta-analysis.

  Xu, Jimmy

  BACKGROUND: The tattooed population has risen significantly over the last few decades, leading to increased scrutiny into potential side effects. The recent publication of scientific articles linking tattooing to lymphoma has led to a systematic review being conducted to investigate if an association exists. METHODS: Following the PICO framework, we formed a systematic review comparing tattooed to non-tattooed adults belonging to any region of the world and investigated the likelihood of lymphomagenesis. The protocol was pre-registered on PROSPERO (ID: CRD42024586505). Relevant studies were searched for in PubMed, Web of Science, Embase, Google Scholar, and CENTRAL on 10/09/2024 and updated on 16/07/25. The inclusion criteria consisted of primary studies, including observational studies and case reports which investigated the association between tattoos and non-Hodgkin lymphoma. Exclusion criteria were publications involving subjects under 18 and non-English papers. Data extraction was performed using published numbers from individual papers after requesting raw data. Study quality was assessed using ROBINS-E, and evidence certainty using GRADE. Outcomes assessed were any odds/risk/incidence ratios that associated tattooing with non-Hodgkin lymphoma. FINDINGS: A total of four observational studies, totalling 17,941 participants (2485 cases and 15,456 controls) and three case reports were identified. None of the included studies demonstrated a statistically proven link between lymphomagenesis and tattooing. ROBINS-E showed relatively low bias for our three included studies; however, the certainty of our evidence is low due to the lack of high-quality studies with similar methodologies. The meta-analysis conducted for non-Hodgkin's lymphoma, with subtypes follicular lymphoma and diffuse large B-cell lymphoma, produced odds ratios of 1.01 (95% CI 0.82-1.24), 1.01 (95% CI 0.77-1.33) and 0.89 (95% CI 0.54-1.46), respectively. INTERPRETATION: No significant association was found between tattooing and lymphoma. Due to limitations in the data quality and lack of standardised measurable outcomes, further high-quality research is needed. FUNDING: There was no funding for this study.
• Consensus on long-term follow-up and surveillance of elective primary shoulder arthroplasty using a real-time Delphi technique.

  Morris, Daniel; Swaile, H; Pitt, Lisa; Bateman, Marcus; Tambe, Amol

  BACKGROUND: Long-term follow-up of elective primary shoulder arthroplasty remains contentious. A real-time Delphi technique allows a single survey to obtain a consensus from experts on the optimum surveillance protocol. METHODS: A real-time Delphi consensus study was delivered using Surveylet. Delphi statements surveyed whether a type of shoulder arthroplasty requires follow-up in the initial 10 postoperative years and beyond 10 postoperative years. Further statements related to surveillance episode format were included. British Elbow and Shoulder Society members were invited to participate. Participants rated agreement with statements using a 5-point Likert scale. Study results were used to produce expert-opinion recommendations that were presented to a patient group. RESULTS: The study received 37 responses of which 31 were complete. 78% of respondents were orthopaedic surgeons and 19% were physiotherapists. Mean survey visits per participant was 3.8 (total 140). The patient group included 13 patients. Consensus agreement was reached on surveillance requirement for numerous shoulder arthroplasty types and aspects of surveillance format, including requirement for radiological assessment and completion of a patient-reported outcome measure. All patients expressed agreement with the resulting expert-opinion recommendations. DISCUSSION: A real-time Delphi among expert clinicians identified areas of consensus in long-term surveillance of elective primary shoulder arthroplasty.

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