A Medical Device Daily

Varian Medical Systems (Palo Alto, California) said Istituto Oncologico della Svizzera Italiana (IOSI; Bellinzona, Switzerland) is among the first cancer clinics worldwide to use a new, faster radiotherapy technology from Varian to treat a child.

A 12-year-old girl with Hodgkin's lymphoma was treated using Varian's RapidArc technique at IOSI. The girl received a targeted radiotherapy dose in less than 2-1/2 minutes, using two continuous revolutions of the device while she lay on the treatment machine.

The company said the RapidArc treatment was "considerably faster" than would have been possible with conventional intensity modulated radiotherapy (IMRT) treatments, "which are slower and more difficult for radiotherapy radiographers because they target tumors using a complex sequence of fixed beams from multiple angles."

IOSI in November became the first hospital in Switzerland to commence treatments using RapidArc. The hospital treats 700 patients a year on two Varian Clinac medical linear accelerators, with RapidArc volumetric modulated arc therapy (VMAT) capability having been added to one of those machines.

Radiation oncologist Dr. Alessandra Franzetti-Pellanda said, "Treating children with cancer is always challenging, but RapidArc enables us to deliver extremely precise treatments much more quickly than would have been possible previously, making it a ... more comfortable experience for the patient while minimizing damage to healthy tissue."

She added that faster treatment means "less chance for the patient to move during delivery, which helps precision. It can also be uncomfortable lying on the couch so to be able to reduce the time of treatment while enhancing the precision is tremendously helpful."

Franzetti-Pellanda worked with head medical physicist Dr. Antonella Fogliata and medical oncologist Dr. Pierluigi Brazzola to carry out the pioneering treatment.

"Lymphoma is a good candidate for radiotherapy because it's a disease that is highly responsive to radiation, even the lower doses that we use in pediatric cases," said Fogliata. "In this RapidArc treatment, the bilateral lung and the lymphatic chains were treated at once using a technique called a simultaneous integrated boost and we are very pleased with the response."

Rolf Staehelin, Varian's European marketing director, said the work by the IOSI team was "an extraordinary achievement ... it demonstrates that RapidArc can be beneficial for highly complex indications such as Hodgkin's lymphoma as well as more conventional tumor sites such as prostate and head and neck."

Gender inequities in reperfusion

A paper published online by the journal Circulation earlier this month concluded that, while men and women have a similar in-hospital death rate following acute myocardial infarction, women with ST-elevation myocardial infarction (STEMI) had an adjusted mortality rate almost twice as high as men (10.2% vs. 5.5%).

The paper said these differences were associated with a lower likelihood of reperfusion therapy in women.

The European Society of Cardiology (ESC; Sophia Antipolis, France) said the study is one of many undertaken in the past 20 years on gender differences in the management of acute coronary events. Many of these studies, like this one, have found that women are treated less intensively in the acute phase.

However, after adjustment for age, co-morbidity and severity of disease, some of these disparities have been found to disappear. Similarly, many studies have found gender differences in short-term survival rates after AMI, but such differences have not always persisted in the long term.

In Europe, results from a Swedish cohort study of 53,781 subjects (of whom 37% were women) also showed that overall women were less intensively treated than men, but, in cases of non-STEMI, had a better long-term prognosis than men.

Commenting for the ESC on the STEMI results in the Circulation paper, Eva Swahn, MD, of University Hospital (Link ping, Sweden), said, "We are not surprised. We found similar results in our Swedish cohort study."

Although the incidence of AMI is low in both sexes, especially in premenopausal women, the view persists – mistakenly – that women don't have the same coronary symptoms as men.

"This is a myth," said Swahn, who has conducted gender studies in acute coronary syndrome patients. "The classical symptoms of AMI are the same for women as for men."

However, she said this mistaken belief may explain why reperfusion therapy is not started as quickly in women as in men – because women interpret their symptoms differently from men and may not summon help soon enough.

While there are some recurring patterns in the studies, including less-intensive treatment in women and lower survival rates in female STEMI patients, ESC said much of the explanation for the disparities remains unknown.

MRSA infections continue to fall

MRSA bloodstream infections in England are continuing to fall, according to the latest quarterly statistics from the UK Health Protection Agency.

There were 725 MRSA bloodstream infections in England between July and September, according to the report. This represents a 13% decrease from the previous quarter, when there were 837 cases, and a 33% reduction from the corresponding quarter of 2007.

This continued downward trend follows the achievement by the NHS of halving MRSA bloodstream infections across England, officials said.

Health Minister Ann Keen said, "Our strategy for tackling infection, including extra investment, tighter regulation and tough actions such as increasing the number of matrons to more than 5,000 and the bare-below-the-elbows dress code to support hand hygiene are clearly having an impact."

She added, "We have set a target for the NHS to sustain this reduction in MRSA infections and deliver a 30% reduction in C. difficile in the next three years. We ... are developing a national minimum standard for MRSA infection that all Trusts must meet."