Asunto(s)
Terapias Complementarias/efectos adversos , Terapias Complementarias/enfermería , Neoplasias/enfermería , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Ensayos Clínicos como Asunto , Aprobación de Drogas , Humanos , Inyecciones Subcutáneas , Muérdago , Neoplasias/terapia , Extractos Vegetales/efectos adversos , Extractos Vegetales/uso terapéutico , Piruvatos/efectos adversos , Piruvatos/uso terapéutico , CharlataneríaAsunto(s)
Actitud del Personal de Salud , Países en Desarrollo , Salud Global , Política de Salud , Política , Adulto , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/enfermería , Neoplasias de la Mama/terapia , Niño , China , Estudios Transversales , Femenino , Disparidades en Atención de Salud , Humanos , Recién Nacido , Masculino , Medicina Tradicional China , Persona de Mediana Edad , Regulación de la Población , EmbarazoAsunto(s)
Fertilización In Vitro/enfermería , Edad Materna , Selección de Personal , Mujeres Trabajadoras , Femenino , Congelación , Alemania , Humanos , Óvulo , Embarazo , Resultado del TratamientoRESUMEN
INTRODUCTION: In future there will be major problems in gynecologic oncology concerning the changes in epidemiology, etiology and the individualized multidisciplinary treatment modalities. The gynecologic oncology has to realize the rising incidence of elderly patients and in correlation to the age and the demography of the increase in breast and vulvar cancer. MATERIALS AND METHODS: The literature and the own experience support the use of similar diagnostic and therapeutic efforts for elderly and younger women with modification for elderly patients based only on the comorbidity. For elderly patients, a breast conserving therapy should be preferred as in younger patients. In vulvar cancer, an individualized therapy is also possible. In patients with endometrial cancer, the systematic lymphnode dissection should be realized. CONCLUSION: The radicality does not depend on the measurement of depth of invasion based on the intraoperative frozen section. Only the surgical removal and histologic evaluation of the nodes may accurately determine the actual nodal status. In lymphnode negative patients, the postoperative adjuvant radiotherapy is preventable.
Asunto(s)
Neoplasias de los Genitales Femeninos/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Ginecología/métodos , Humanos , Oncología Médica/métodos , Persona de Mediana Edad , Adulto JovenAsunto(s)
Ensayos Clínicos como Asunto/ética , Ensayos Clínicos como Asunto/enfermería , Industria Farmacéutica/ética , Industria Farmacéutica/legislación & jurisprudencia , Ética en Investigación , Experimentación Humana/ética , Experimentación Humana/legislación & jurisprudencia , Programas Nacionales de Salud/ética , Programas Nacionales de Salud/legislación & jurisprudencia , Adulto , Niño , Ensayos Clínicos como Asunto/legislación & jurisprudencia , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/inducido químicamente , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/enfermería , Europa (Continente) , Alemania , Adhesión a Directriz/ética , Adhesión a Directriz/legislación & jurisprudencia , Humanos , Política , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Ensayos Clínicos Controlados Aleatorios como Asunto/legislación & jurisprudencia , Ensayos Clínicos Controlados Aleatorios como Asunto/enfermería , Medición de Riesgo/ética , Medición de Riesgo/legislación & jurisprudencia , Estados UnidosRESUMEN
BACKGROUND: Breast cancer with extensive axillary-lymph-node involvement has a poor prognosis after conventional treatment. In trials with historical controls, high-dose chemotherapy produced improved outcomes. We compared an intensive double-cycle high-dose chemotherapy regimen with an accelerated conventionally dosed regimen in high-risk breast cancer in a multicentre trial. METHODS: Patients with at least nine positive nodes were randomly assigned either two courses of accelerated (2-week intervals, with filgrastim support), conventionally dosed epirubicin and cyclophosphamide followed by two courses of high-dose chemotherapy (epirubicin, cyclophosphamide, and thiotepa supported by peripheral-blood progenitors) or four identical cycles of epirubicin and cyclophosphamide followed by three cycles of accelerated cyclophosphamide, methotrexate, and fluorouracil. The primary endpoint was event-free survival. Analyses were done both by intention to treat and per protocol. FINDINGS: 403 patients were enrolled; 201 were assigned high-dose chemotherapy and 202 conventional treatment. The mean number of positive nodes was 17.6, and median follow-up was 48.6 months. 4-year event-free survival (intention-to-treat analysis) was 60% (95% CI 53-67) in the high-dose chemotherapy group and 44% (37-52) in the control group (p=0.00069). The corresponding overall survival was 75% (69-82) versus 70% (64-77; p=0.02). There were no treatment-related deaths. INTERPRETATION: Our finding of significant improvements in both event-free and overall survival for high-dose chemotherapy compared with a dose-dense conventional regimen contrasts with the results of other studies. The discrepancy might be due partly to design differences (tandem, brief induction) between our regimen and those studied in other trials. This approach merits further study.