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1.
Neurochirurgie ; 64(6): 415-421, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30424956

RESUMO

PURPOSE: The management of malignant brain metastases becomes a main issue for the treatment of patients, because of the survival extension related to the improvement in systemic treatments. Robotic stereotactic radiosurgery (RSR) is a new approach in this indication. The purpose of this analysis was to define the efficacy of RSR, in order to determine prognostic factors of survival and factors of response. PATIENTS AND METHODS: It was a retrospective, single center (polyclinique de Bordeaux Nord Aquitaine) analysis performed from 2012 to 2015, involving patients with malignant brain metastases treated by RSR using the Cyberknife® technique. We analyzed the following parameters: response to RSR, prognostic and predictive factors of response, and survival. RESULTS: A total of 72 RSRs were performed among 55 analyzed patients; 62 treatments were assessable with a median follow-up of 9.4 months. The main delivered dose on the 80%-isodose was 20Gy. A complete response was achieved in 40.3% of patients (stability or regression=83.9%). The overall survival was 13 months. The risk of failure was significantly correlated with the increase in metastasis size and non-adenocarcinoma histology. A performance status<2 was the main prognostic factor of survival. CONCLUSIONS: The RSR allowed treating 3 to 5 brain metastases, avoiding an entire brain irradiation, and maintaining survival and quality of life.


Assuntos
Neoplasias Encefálicas/cirurgia , Radiocirurgia , Procedimentos Cirúrgicos Robóticos , Robótica , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/cirurgia , Neoplasias Encefálicas/patologia , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/terapia , Qualidade de Vida , Radiocirurgia/métodos , Indução de Remissão
2.
Ann Oncol ; 23(4): 919-27, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21825101

RESUMO

BACKGROUND: We investigated whether circulating endothelial cells (CECs) predict clinical outcome of first-line chemotherapy and bevacizumab in metastatic colorectal cancer (mCRC) patients. PATIENTS AND METHODS: In a substudy of the randomized phase II FNCLCC ACCORD 13/0503 trial, CECs (CD45- CD31+ CD146+ 7-amino-actinomycin- cells) were enumerated in 99 patients by four-color flow cytometry at baseline and after one cycle of treatment. We correlated CEC levels with objective response rate (ORR), 6-month progression-free survival (PFS) rate (primary end point of the trial), PFS, and overall survival (OS). Multivariate analyses of potential prognostic factors, including CEC counts and Köhne score, were carried out. RESULTS: By multivariate analysis, high baseline CEC levels were the only independent prognostic factor for 6-month PFS rate (P < 0.01) and were independently associated with worse PFS (P = 0.02). High CEC levels after one cycle were the only independent prognostic factor for ORR (P = 0.03). High CEC levels at both time points independently predicted worse ORR (P = 0.025), 6-month PFS rate (P = 0.007), and PFS (P = 0.02). Köhne score was the only variable associated with OS. CONCLUSION: CEC levels at baseline and after one treatment cycle may independently predict ORR and PFS in mCRC patients starting first-line bevacizumab and chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Células Endoteliais/patologia , Endotélio Vascular/patologia , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Capecitabina , Contagem de Células , Neoplasias Colorretais/sangue , Neoplasias Colorretais/mortalidade , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Citometria de Fluxo , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Humanos , Irinotecano , Estimativa de Kaplan-Meier , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Agressologie ; 30(7): 411-5, 1989 Jun.
Artigo em Francês | MEDLINE | ID: mdl-2817238

RESUMO

Fifteen patients with ruptured intracranial aneurysm have been operated before undergoing post surgery xenon inhalation for cerebral blood flow valuation: first measurement has been performed as CBF reference; 2nd measurement has been done after 0.1 mg.kg-1 I.V. bolus of nicardipine; sides effects are mainly due to BP fall 2/15 and some consequent neurological distress have been noticed (2/15); results should be carefully interpreted. Significant CBF increase have been measured after nicardipine injection, specially in brain area correlated to low CBF before injection (the lower the CBF, the higher the increase of local flow). The study prompt us to check the effect of nicardipine on patient (with CBF measurement after nicardipine test) before giving the treatment. Problems remain to be solved with further studies and not yet established: correlation between hemodynamics changes and clinical status and also which time of disease evolution is the best to be treated.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Aneurisma Intracraniano/tratamento farmacológico , Nicardipino/farmacologia , Hemorragia Subaracnóidea/tratamento farmacológico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Injeções Intravenosas , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Nicardipino/administração & dosagem , Hemorragia Subaracnóidea/etiologia
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