RESUMEN
We explored activity and safety of a dose-dense/dose-intense adriamycin, bleomycin, vinblastine and dacarbazine regimen (ABVDDD-DI ) in 82 patients with advanced Hodgkin Lymphoma. Patients entered a two-stage Bryant-Day Phase II study to receive six cycles of ABVDDD-DI without consolidation radiotherapy. Cycles were supported with granulocyte colony-stimulating factor and delivered every 21 d; drugs were administered on days 1 and 11 at the same doses of standard ABVD except for doxorubicin (35 mg/m2; first four cycles only). Co-primary endpoints were complete response (CR) rate and severe acute cardiopulmonary toxicity; secondary endpoints were event-free (EFS) and disease-free survival (DFS). All patients received the four doxorubicin-intensified courses and 96% concluded all six cycles (82.3% within the intended 18 weeks). This translated into a 66.9% increase of received dose-intensity for doxorubicin and 31.8% for the other agents over standard ABVD. The CR rate was 95.1% (78/82) and 87.8% (72/82) achieved a metabolic CR after two cycles. Cardiopulmonary toxicity never exceeded grade 2 and affected 14.6% of patients. Most frequent toxicities were grade 4 neutropenia (10%) and anaemia (9%), grade 3 infection (17%) and grade 2 mucocutaneous changes (30%). Five-year EFS and DFS was 88.3% and 93.7%, respectively. ABVDDD-DI regimen was well-tolerated and ensured substantial CR and EFS rates without radiotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Enfermedad de Hodgkin/tratamiento farmacológico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Dacarbazina/administración & dosificación , Dacarbazina/efectos adversos , Dacarbazina/uso terapéutico , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Esquema de Medicación , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/patología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radioterapia Adyuvante , Resultado del Tratamiento , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , Vinblastina/uso terapéutico , Adulto JovenAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Resistencia a Antineoplásicos/genética , Receptores ErbB/genética , Neoplasias Pulmonares/tratamiento farmacológico , Mutación/genética , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinazolinas/uso terapéutico , Anciano , Carcinoma de Células Grandes/tratamiento farmacológico , Carcinoma de Células Grandes/genética , Carcinoma de Pulmón de Células no Pequeñas/genética , Receptores ErbB/antagonistas & inhibidores , Gefitinib , Humanos , Neoplasias Pulmonares/genética , Masculino , Metástasis de la Neoplasia , PronósticoAsunto(s)
Adenocarcinoma/secundario , Antineoplásicos/uso terapéutico , Neoplasias Pulmonares/patología , Células Neoplásicas Circulantes/patología , Tomografía de Emisión de Positrones , Quinazolinas/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/genética , Adulto , Receptores ErbB/antagonistas & inhibidores , Receptores ErbB/genética , Gefitinib , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/genética , Masculino , Mutación/genética , PronósticoAsunto(s)
Condrosarcoma/cirugía , Recurrencia Local de Neoplasia/cirugía , Procedimientos de Cirugía Plástica/métodos , Neoplasias Torácicas/cirugía , Pared Torácica/cirugía , Materiales Biocompatibles/uso terapéutico , Trasplante Óseo , Humanos , Ilion/trasplante , Masculino , Metilmetacrilato/uso terapéutico , Persona de Mediana Edad , Epiplón/trasplante , Politetrafluoroetileno/uso terapéutico , Reoperación , Trasplante de Piel , Colgajos Quirúrgicos , Mallas QuirúrgicasRESUMEN
The aim of our study was to evaluate the reliability of MDCT-enteroclysis (MDCT-E), an emerging technique of small bowel examination that combines the advantages of MDCT examination of the abdomen and the enteral volume challenge of enteroclysis, in evaluation of small bowel neoplasms. In our institutions, MDCT-E was used to study 456 patients (age range 21-84 years, mean 53 years) admitted for suspicion of small bowel disease. All examinations were done on multichannel CT units, 129 on a 16-slice scanner and 327 on a four-slice scanner. Post-processing and multiplanar reformatting and interpretation were performed on dedicated workstations. After adequate gastrointestinal preparation and naso-enteric intubation, small bowel was distended by methylcellulose infused by a peristaltic pump. One volumetric MDCT acquisition was obtained after 120-130 ml of intravenous contrast medium. Multiplanar reformatting was based on the image reconstruction parameters from 3 to 4 mm. Forty-five small bowel neoplasms were found; in the remaining cases, 223 Crohn's diseases and 149 other abnormalities were detected. All findings were confirmed by surgery, endoscopy or clinical follow-up. In our experience, MDCT-E with neutral enteral and IV contrast seems to be a reliable method in the diagnosis of small bowel neoplasms.
