RESUMEN
BACKGROUND: Induction chemotherapy (IC) followed by concomitant chemoradiotherapy (CCRT) has the potential of being an ideal multi-modality approach for improving the prognosis of patients with squamous cell carcinoma of the head and neck (SSCHN). PATIENTS AND METHODS: Thirty-four patients with locally advanced SCCHN were treated with 3 cycles of IC, consisting of docetaxel 75 mg/m2 and cisplatin 75 mg/m2 every 3 weeks, followed 3-4 weeks later by definitive radiotherapy (70 Gy) and concomitant weekly cisplatin 40 mg/m2. RESULTS: After a median follow-up of 27.7 months, 6-month progression-free survival (PFS), the primary study end-point, was 84%. The median PFS was 16.4 months and median overall survival 24.4 months. The majority of the patients completed 3 cycles to moderate toxicity. Anemia, nausea/vomiting and mucositis were the prominent toxicities during CCRT. Retrospective analysis of a panel of biomarkers suggested that excision repair cross-complementation group 1 (ERCC1) protein expression was associated with shorter PFS. CONCLUSION: IC followed by CCRT, as administered in the present study, is a feasible and well-tolerated therapeutic approach. However, its real impact on the prognosis of SCCHN patients has to be demonstrated in a randomized study comparing this treatment to CCRT alone.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Adulto , Anciano , Carcinoma de Células Escamosas/genética , Cisplatino/administración & dosificación , Terapia Combinada , Supervivencia sin Enfermedad , Docetaxel , Femenino , Amplificación de Genes , Genes erbB-2 , Neoplasias de Cabeza y Cuello/genética , Humanos , Hibridación Fluorescente in Situ , Masculino , Persona de Mediana Edad , Inducción de Remisión , Taxoides/administración & dosificaciónRESUMEN
Zygomycosis, a relatively uncommon infection, usually occurs among immunocompromised individuals. It has been reported only rarely in trauma patients. A fatal case is reported of pulmonary and rapidly progressive cutaneous zygomycosis in a young, otherwise healthy farmer, with multiple bone fractures, wounds and soft tissue injuries after an accident with an agricultural machine in the field. Rhizopus spp. was isolated from both cultures of bronchial washings and wound samples. The diagnosis was confirmed by histopathological examination of tissue specimens from a large wound. Despite systemic antifungal therapy and surgical debridement, the patient's condition deteriorated and he died from refractory septic shock.