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Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
We conducted unmanned aerial vehicle lidar missions in the Maya Lowlands between June 2017 and June 2018 to develop appropriate methods, procedures, and standards for drone lidar surveys of ancient Maya settlements and landscapes. Three site locations were tested within upper Usumacinta River region using Phoenix Lidar Systems: Piedras Negras, Guatemala, was tested in 2017, and Budsilha and El Infiernito, both in Mexico, were tested in 2018. These sites represent a range of natural and cultural contexts, which make them ideal to evaluate the usefulness of the technology in the field. Results from standard digital elevation and surface models demonstrate the utility of deploying drone lidar in the Maya Lowlands and throughout Latin America. Drone survey can be used to target and efficiently document ancient landscapes and settlement. Such an approach is adaptive to fieldwork and is cost effective but still requires planning and thoughtful evaluation of samples. Future studies will test and evaluate the methods and techniques for filtering and processing these data.
Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.