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  1. Candy Lee
  1. Correspondence to Dr Candy Lee, ST7 Specialty Trainee in Respiratory Medicine and General Internal Medicine, Cardiff & Vale University Health Board, University Hospital LLandough, Penlan Road, Llandough, Penarth CF64 2XX, UK; clee128{at}

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Use of prophylactic radiotherapy in mesothelioma

A well-recognised complication of pleural intervention in mesothelioma patients are pleural tract metastases. Prophylactic radiotherapy is often used to prevent this complication but clinical practice varies greatly due to lack of evidence regarding the efficacy of its use. In this multi-centred, open labelled, phase 3, randomised controlled trial (Lancet Oncol 2016;17:1094–104), researchers demonstrated no significant difference in the incidence of pleural tract metastases in patients who received immediate prophylactic radiotherapy following a large-bore pleural procedure and in those that had treatment-focused radiotherapy when metastases occurred (9% vs 16% respectively, p=0.14). No benefits in symptom control, analgesia use, survival or quality of life were reported with the use of prophylactic radiotherapy. The authors concluded that the routine use of prophylactic radiotherapy, post large-bore pleural interventions in all mesothelioma patients, was not justified.

Another reason to stop smoking

In this prospective population study (Stroke 2016;47:1975–81. doi: 10.1161/STROKEAHA.116.012957), smoking was found to have dose-dependent and cumulative associations with subarachnoid haemorrhage risk. Smoking was demonstrated to increase the risk of bleeding for …

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