RESUMEN
BACKGROUND: Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective. PATIENTS AND METHODS: We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score. RESULTS: Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4). CONCLUSIONS: This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.
Asunto(s)
Neoplasias de la Mama/terapia , Sesgo de Selección , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Femenino , Humanos , Persona de Mediana Edad , Calidad de la Atención de Salud , Suiza/epidemiologíaRESUMEN
PURPOSE: To investigate the feasibility and outcome of bifractionated, up-front thoracic radiotherapy (TR) (45 Gy in 30 fractions of 1.5 Gy twice daily over 3 weeks) combined with chemotherapy (CT) (six cycles of cisplatin and etoposide) and optional low-dose, up-front prophylactic cranial irradiation (18 Gy in 10 fractions of 1.8 Gy twice daily over 5 days) in limited small-cell lung cancer. PATIENTS AND METHODS: CT (etoposide 100 mg/m(2) for 3 days and cisplatin 25 mg/m(2) for 3 days) was started on day 8 or 15 after the first TR treatment. In the five subsequent cycles, cisplatin was given as a single 100-mg/m(2) dose on day 1 every 4 weeks. A total of 52 patients were entered (41 men and 11 women); the median age was 55 years (range, 33 to 67 years). World Health Organization performance status was 0 in 34 patients, 1 in 16 patients, and 2 in two patients. Thirty-six patients (69%) received the full planned six cycles of CT. RESULTS: All treated patients were assessable for response. Thirty-one patients (60%) achieved a complete response, and 16 (30%) had a partial response. One-, 3-, and 4-year survival rates were 74% (95% confidence interval [CI], 60% to 84%), 34% (95% CI, 21% to 49%), and 32% (95 CI, 16% to 46%), respectively. The median survival time was 18 months. Event-free survival at 1 year was 45% (95% CI, 32% to 58%) and at 3 years, 30% (95% CI, 18% to 44%). The main radiation-related acute toxicity was esophageal: 38% of the patients experienced grade 3 or 4 acute toxicity. CT was well tolerated. Although grade 3/4 neutropenia was observed in 86% of the patients, only 4% presented with associated fever. Grade 3/4 nausea and vomiting was seen in 35% of patients. CONCLUSION: This trial demonstrates that up-front accelerated TR associated with CT is feasible, has acceptable toxicity, and shows considerable long-term survival potential.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/radioterapia , Irradiación Craneana , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Pequeñas/mortalidad , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Fraccionamiento de la Dosis de Radiación , Etopósido/administración & dosificación , Etopósido/efectos adversos , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Traumatismos por Radiación , Dosificación Radioterapéutica , Tasa de SupervivenciaAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/inmunología , Antineoplásicos/uso terapéutico , Linfoma Folicular/terapia , Síndromes Paraneoplásicos/terapia , Pénfigo/complicaciones , Estomatitis/patología , Estomatitis/terapia , Anticuerpos Monoclonales de Origen Murino , Antígenos CD20/análisis , Femenino , Humanos , Linfoma Folicular/complicaciones , Linfoma Folicular/inmunología , Persona de Mediana Edad , Mucosa Bucal/patología , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/inmunología , Pénfigo/inmunología , Pénfigo/patología , Rituximab , Estomatitis/complicaciones , Estomatitis/inmunologíaRESUMEN
Between 1981 and 1988, we recorded 11 patients presenting a neoplastic microangiopathy. All patients suffered from adenocarcinoma, except one with an undifferentiated lung carcinoma; the origin of the tumor was mammary in 5 cases and gastric in 3. In our study, microangiopathy was the first manifestation of the neoplastic disease on 3 occasions; on 7 occasions it was a complication of an advanced stage of a known oncological disease; and on 1 occasion it occurred during a course of intra-arterial chemotherapy. Regenerative anemia (mean 9.5 g/dl hemoglobin), thrombocytopenia (mean 42,000 platelets/mm3), and an elevated LDH value (mean 1,268 U/l) characterized these patients. Disseminated intravascular coagulopathy (DIC) was found in half the cases in which it was sought. In spite of aggressive antitumoral treatment, the course was disastrous with an average survival of 13.6 days. The most frequent causes of death were renal insufficiency or hemorrhagic diathesis. These data corroborate those cited in the literature since 1979, and are consistent with those reported by Antman during the period 1962-1979.
Asunto(s)
Adenocarcinoma/complicaciones , Microcirculación , Neoplasias/complicaciones , Enfermedades Vasculares/etiología , Adenocarcinoma/sangre , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Anemia Hemolítica/etiología , Médula Ósea/patología , Neoplasias de la Mama/sangre , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/patología , Eritrocitos Anormales/patología , Femenino , Humanos , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/patología , Neoplasias Gástricas/sangre , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Enfermedades Vasculares/sangre , Enfermedades Vasculares/patologíaRESUMEN
In a prospective randomized study we investigated the potential of subcutaneous recombinant human erythropoietin (rhEpo) as adjuvant treatment for autologous blood transfusions (3 units) in elective surgery. Four and 2 weeks before surgery, 49 patients received 6 x 10,000 U of rhEpo. delta Hb values (days -28 and 0) of the rhEpo group were compared to delta Hb values of 52 controls (no rhEpo). Reticulocytes were measured at days -21, -14, -7 and 0. Peri- and postoperative supplementary homologous blood requirements were compared in the two randomized groups. delta Hb of rhEpo group was 0.96 g/dl (mean value) and 2.38 for controls. Reticulocyte count increased earlier and to higher levels in rhEpo-treated patients. Except in 1 case, Epo was well tolerated. These results indicate that autologous predonation (3 x 400 ml) does not create anemia if adjuvant Epo treatment is given. However, homologous blood requirements were not significantly different, which is probably due to the fact that 96 of the 101 treated patients underwent elective orthopedic surgery requiring limited blood replacement. Significant benefit of the Epo regimen can be expected in elective cardiovascular and hepatic surgery where larger amounts of blood (5-6 units) are needed.
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Anemia/prevención & control , Transfusión de Sangre Autóloga , Eritropoyetina/uso terapéutico , Adulto , Anciano , Eritropoyesis/efectos de los fármacos , Eritropoyetina/farmacología , Femenino , Ácido Fólico/uso terapéutico , Humanos , Hierro/uso terapéutico , Masculino , Persona de Mediana Edad , Ortopedia , Cuidados Preoperatorios , Estudios Prospectivos , Proteínas Recombinantes/uso terapéutico , Vitamina B 12/uso terapéuticoRESUMEN
We performed a trial using the combination of epirubicin 50 mg/m2/day 1, carboplatinum AUC 5/day 1 and continuous 5-fluorouracil (5-FU) 200 mg/m2/day (every 4 weeks for 6 months) to confirm the efficacy and low toxicity profile of this regimen in breast cancer. In 51 patients with metastatic (n = 33) or locally advanced (n = 18) breast cancer the overall response rate was 86% (95% confidence interval (95% CI): 73%-94%): 94% in locally advanced and 81% metastatic disease. Grade 3-4 toxicity was low: 4% of patients presented with febrile neutropenia, 16% with severe palmar-plantar syndrome, 10% with Port-a-cath thrombosis. This study confirms the high efficacy of infusional 5-FU-based regimens and justifies further research into novel promising oral 5-FU derivatives.