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1.
Int J Paleopathol ; 37: 23-29, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35366493

RESUMEN

OBJECTIVE: Palaeopathological evidence of cancer, especially metastatic cancer, is rare in China. This paper describes and diagnoses a cranium with multiple lytic lesions recovered from the Sampula cemetery in Xinjiang, attempting to diagnose the type of disease that could have caused the pathological lesions observed. MATERIAL: A cranium from an adult male (#00106) was recovered from the Sampula cemetery (dated to 55 BCE to 335 CE) located in the Luopu County, the Hotan River oasis on the southern edge of the Tarim Basin in southern Xinjiang. METHODS: The cranium was assessed macroscopically and radiographically (CT). RESULTS: Multiple osteolytic lesions with irregular and "moth-eaten" margins were detected in cranium #00106. CT scans revealed the development of the lesions began at the diploe and identified a "button sequestrum". CONCLUSIONS: Based on lesion characteristics, metastatic carcinoma was likely the cause of lesions found in cranium #00106. SIGNIFICANCE: This case has expanded our knowledge of the malignant neoplasms of ancient populations in northwest China and discusses the possible risk factors in the occurrence of cancer in the Sampula site, as well as the possible impacts of skeletal metastases on the individual. LIMITATIONS: The distribution of osteolytic lesions over the complete skeleton cannot be observed because of the unavailability of postcranial bone. SUGGESTIONS FOR FUTURE RESEARCH: With the increasing number of reports describing diseases in ancient China, the patterns of diseases occurrence and development can be further explored from spatial and temporal perspectives.


Asunto(s)
Carcinoma , Carcinoma/secundario , Cementerios , China , Historia Antigua , Humanos , Masculino , Cráneo/patología
2.
J Clin Oncol ; 39(30): 3364-3376, 2021 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-34339289

RESUMEN

PURPOSE: In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for patients eligible for curative-intent surgery. This study evaluated the effect of regionalization on outcomes. METHODS: The retrospective cohort study included gastric cancer cases diagnosed from January 2010 to May 2018. Information was obtained from the electronic medical record, cancer registry, state vital statistics, and chart review. Overall survival was compared in patients with all stages of disease, stage I-III disease, and curative-intent gastrectomy patients using annual inception cohorts. For the latter, the surgical approach and surgical outcomes were also compared. RESULTS: Among 1,429 eligible patients with gastric cancer with all stages of disease, one third were treated after regionalization, 650 had stage I-III disease, and 394 underwent curative-intent surgery. Among surgical patients, neoadjuvant chemotherapy utilization increased from 35% to 66% (P < .0001), laparoscopic gastrectomy increased from 18% to 92% (P < .0001), and D2 lymphadenectomy increased from 2% to 80% (P < .0001). Dissection of ≥ 15 lymph nodes increased from 61% to 95% (P < .0001). Surgical complication rates did not appear to increase after regionalization. Length of hospitalization decreased from 7 to 3 days (P < .001). Overall survival at 2 years was as follows: all stages, 32.8% pre and 37.3% post (P = .20); stage I-III cases with or without surgery, 55.6% and 61.1%, respectively (P = .25); and among surgery patients, 72.7% and 85.5%, respectively (P < .03). CONCLUSION: Regionalization of gastric cancer care within an integrated system allowed comprehensive multidisciplinary care, conversion to laparoscopic gastrectomy and D2 lymphadenectomy, increased overall survival among surgery patients, and no increase in surgical complications.


Asunto(s)
Instituciones Oncológicas/organización & administración , Carcinoma/terapia , Prestación Integrada de Atención de Salud/organización & administración , Gastrectomía/estadística & datos numéricos , Neoplasias Gástricas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California , Carcinoma/secundario , Prestación Integrada de Atención de Salud/normas , Femenino , Gastrectomía/efectos adversos , Gastrectomía/métodos , Humanos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Escisión del Ganglio Linfático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de Supervivencia , Resultado del Tratamiento , Adulto Joven
4.
Can J Surg ; 63(1): E71-E79, 2020 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-32080999

RESUMEN

Background: Peritoneal recurrences after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancers are frequent. This study aimed to evaluate the safety, technical feasibility and perioperative and long-term outcomes of repeat CRS/HIPEC in patients with recurrent peritoneal carcinomatosis of colorectal and appendiceal origin. Methods: Data were collected from patients treated from 2000 to 2016 for recurrent peritoneal carcinomatosis from appendiceal or colorectal cancer with CRS/HIPEC at 2 specialist centres. Data on demographics, procedure details, morbidity and survival were recorded. Analyses compared the iterations of CRS/HIPEC to assess the safety and effectiveness of repeat surgery. Results: Of all patients who underwent CRS/HIPEC in the 2 centres, 37 patients underwent a repeat procedure. Operative time was similar for the first and second surgeries (412.1 v. 412.5 min, p = 0.74) but patients had a significantly lower peritoneal carcinoma index score with the second surgery (21.8 in the first iteration v. 9.53 in the second iteration, p < 0.001) and significantly less blood loss (1762 mL in the first iteration v. 790 mL in the second iteration, p = 0.001). There was a nonsignificant decrease in grade III­IV complications and there was no 30-day mortality associated with repeat procedures. For patients with colorectal cancer, median disease-free survival was 9.6 months and median overall survival was 40 months. For patients with appendiceal cancer, median disease-free survival was 15 months and overall survival was 64.4 months. Conclusion: Repeat CRS/HIPEC procedures for recurrent appendiceal and colorectal peritoneal carcinomatosis are safe in well-selected patients, without increased morbidity or mortality, and they are associated with significant long-term survival, particularly for patients with appendiceal cancers. These results support the use of repeat CRS/HIPEC in these patients.


Contexte: Les récurrences péritonéales après une chirurgie cytoréductrice (CCR) et une chimiothérapie hyperthermique intrapéritonéale (CHIP) pour les cancers de l'appendice et colorectaux sont fréquentes. Cette étude visait à évaluer l'innocuité, la faisabilité technique et les résultats périopératoires et à long terme d'une reprise de CCR/CHIP chez les patients qui présentent une récurrence de carcinomatose péritonéale ayant son origine au niveau colorectal ou de l'appendice. Méthodes: Des données ont été recueillies sur des patients traités entre 2000 et 2016 pour une récurrence de carcinomatose péritonéale ayant son origine au niveau colorectal ou de l'appendice par CCR/CHIP dans 2 centres spécialisés. On a tenu compte des données démographiques, des détails des interventions, ainsi que de la morbidité et de la survie. Des analyses ont permis de comparer les premières et deuxièmes CCR/CHIP pour évaluer l'innocuité et l'efficacité des chirurgies répétées. Résultats: De tous les patients soumis à des CCR/CHIP dans les 2 centres, 37 ont subi l'intervention de nouveau. Le temps opératoire a été similaire pour les premières et les deuxièmes chirurgies (412,1 c. 412,5 min, p = 0,74), mais les patients présentaient un score de carcinomatose péritonéale beaucoup plus bas lors de la deuxième chirurgie (21,8 pour la première intervention c. 9,53 pour la seconde, p < 0,001) et des pertes sanguines significativement moindres (1762 mL pour la première intervention c. 790 mL pour la seconde, p = 0,001). On a noté une diminution non significative des complications de grades III­IV et on n'a déploré aucune mortalité à 30 jours en lien avec la reprise de l'intervention. Pour les patients atteints d'un cancer colorectal, la survie médiane sans maladie a été de 9,6 mois et la survie médiane globale a été de 40 mois. Pour les patients atteints d'un cancer de l'appendice, la survie médiane sans maladie a été de 15 mois et la survie médiane globale a été de 64,4 mois. Conclusion: La reprise des CCR/CHIP pour les récurrences de carcinomatose péritonéale ayant leur origine au niveau colorectal ou de l'appendice est sécuritaire chez les patients soigneusement sélectionnés, sans accroissement de la morbidité ou de la mortalité, et elles sont associées à une survie à long terme significative, particulièrement chez les patients ayant un cancer de l'appendice. Ces résultats appuient la reprise des CCR/CHIP chez ces patients.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Apéndice/terapia , Carcinoma/terapia , Neoplasias Colorrectales/terapia , Procedimientos Quirúrgicos de Citorreducción , Hipertermia Inducida , Recurrencia Local de Neoplasia/terapia , Evaluación de Resultado en la Atención de Salud , Neoplasias Peritoneales/terapia , Reoperación , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias del Apéndice/mortalidad , Neoplasias del Apéndice/patología , Canadá/epidemiología , Carcinoma/mortalidad , Carcinoma/secundario , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Terapia Combinada , Estudios Transversales , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Estudios de Factibilidad , Femenino , Humanos , Hipertermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/secundario , Reoperación/efectos adversos , Reoperación/mortalidad , Estudios Retrospectivos
5.
World J Urol ; 38(3): 637-645, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30701334

RESUMEN

PURPOSE: Fatty acid-binding protein 5 (FABP5), a transport protein for lipophilic molecules, has been proposed as protein marker in prostate cancer (PCa). The role of FABP5 gene expression is merely unknown. METHODS: In two cohorts of PCa patients who underwent radical prostatectomy (n = 40 and n = 57) and one cohort of patients treated with palliative transurethral resection of the prostate (pTUR-P; n = 50) FABP5 mRNA expression was analyzed with qRT-PCR. Expression was correlated with clinical parameters. BPH tissue samples served as control. To independently validate findings on FABP5 expression, three microarray and sequencing datasets were reanalyzed (MSKCC 2010 n = 216; TCGA 2015 n = 333; mCRPC, Nature Medicine 2016 n = 114). FABP5 expression was correlated with ERG-fusion status, TCGA subtypes, cancer driver mutations and the expression of druggable downstream pathway components. RESULTS: FABP5 was overexpressed in PCa compared to BPH in the cohorts analyzed by qRT-PCR (radical prostatectomy p = 0.003, p = 0.010; pTUR-P p = 0.002). FABP5 expression was independent of T stage, Gleason Score, nodal status and PSA level. FABP5 overexpression was associated with the absence of TMPRSS2:ERG fusion (p < 0.001 in TCGA and MSKCC). Correlation with TCGA subtypes revealed FABP5 overexpression to be associated with SPOP and FOXA1 mutations. FABP5 was positively correlated with potential drug targets located downstream of FABP5 in the PPAR-signaling pathway. CONCLUSION: FABP5 overexpression is frequent in PCa, but seems to be restricted to TMPRESS2:ERG fusion-negative tumors and is associated with SPOP and FOXA1 mutations. FABP5 overexpression appears to be indicative for increased activity in PPAR signaling, which is potentially druggable.


Asunto(s)
Carcinoma/genética , Proteínas de Unión a Ácidos Grasos/genética , Expresión Génica , Neoplasias de la Próstata/genética , ARN Mensajero/metabolismo , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/secundario , Carcinoma/cirugía , Estudios de Casos y Controles , Factor Nuclear 3-alfa del Hepatocito/genética , Humanos , Masculino , Persona de Mediana Edad , Mutación , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Proteínas Nucleares/genética , Proteínas de Fusión Oncogénica/genética , Cuidados Paliativos , Receptores Activados del Proliferador del Peroxisoma/metabolismo , Prostatectomía , Hiperplasia Prostática/genética , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Proteínas Represoras/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal , Resección Transuretral de la Próstata
6.
Eur J Surg Oncol ; 46(4 Pt A): 577-581, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31677939

RESUMEN

INTRODUCTION: Morbidity associated with cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is due to the synergistic effect of cytoreduction, effect hyperthermia and the cytotoxic agents used for HIPEC. This study was done to analyse the postoperative morbidity in relation to the chemotherapy agent used in patients undergoing CRS-HIPEC for peritoneal surface malignancy (PSM) in Indian set up. MATERIALS AND METHODS: Patient with PSM, underwent CRS-HIPEC as per the institutional protocol. Patients were stratified as per the chemotherapy drug used during HIPEC & perioperative outcome were documented. RESULTS: 163 patients underwent CRS-HIPEC for PSM: 67.4% were of ovarian primary. Others were colorectal, appendicular, gastric primary and rare tumors.Cisplatin was the most common drug used: as alone (57.05%) or in combination with Adriamycin (12.88%). Mitomycin-C (MMC) was used in 20% and oxaliplatin in 10%.Grade 3-5 morbidity in the whole cohort was 44.8% and grade 1-2 was 74%.Grade 1-2 electrolyte abnormality was the most common morbidity overall and grade 3-4 hematological toxicity was the most common severe morbidity. Frequency of grade 3-5 morbidity were 38.7%, 48.5%,50% and 61.9% for Cisplatin alone, MMC, oxaliplatin and Adriamycin + cisplatin respectively. None of the patients had grade 3-4 nephrotoxicity as sole complication. All major complications were highest in the group who received Adriamycin. Cisplatin was associated with higher rate of electrolyte imbalance, oxaliplatin with post-operative bleeding. Rates of other complications did not differ significantly. CONCLUSION: Cisplatin followed by MMC were the well tolerated drugs during HIPEC and tolerance to Adriamycin combination regimen in Indian patients was poor.


Asunto(s)
Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma/terapia , Procedimientos Quirúrgicos de Citorreducción , Hipertermia Inducida , Neoplasias Peritoneales/terapia , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Neoplasias del Apéndice/patología , Carcinoma/secundario , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Neoplasias Colorrectales/patología , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Mitomicina/efectos adversos , Neoplasias Ováricas/patología , Oxaliplatino/efectos adversos , Neoplasias Peritoneales/secundario , Complicaciones Posoperatorias/inducido químicamente , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/epidemiología , Neoplasias Gástricas/patología , Desequilibrio Hidroelectrolítico/inducido químicamente , Desequilibrio Hidroelectrolítico/epidemiología
7.
Eur J Surg Oncol ; 46(4 Pt A): 675-683, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31806517

RESUMEN

The presence of peritoneal metastases in patients with advanced colorectal cancer is associated with poor prognosis but the mechanisms for this are unclear. This review summarises the current knowledge of the pathophysiology, clinical features, prevalence, prognosis, and molecular biology of peritoneal metastases and the risk factors for the development of peritoneal metastases following resection of a primary colorectal tumour. Furthermore, the evidence for treatment strategies are described including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, early post-operative intraperitoneal chemotherapy, sequential post-operative intraperitoneal chemotherapy and emerging novel strategies. Active areas of research should include the identification of individuals at high risk of peritoneal metastases after curative resection of primary tumour, development of a surveillance program for high-risk patients, optimisation of systematic therapies and further investigation of the use of intraperitoneal chemotherapy.


Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/terapia , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos de Citorreducción , Neoplasias Peritoneales/terapia , Carcinoma/genética , Carcinoma/secundario , Quimioterapia Adyuvante , Neoplasias Colorrectales/genética , Humanos , Hipertermia Inducida , Inmunoterapia Adoptiva , Infusiones Parenterales , Neoplasias Peritoneales/genética , Neoplasias Peritoneales/secundario , Pronóstico , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Factores de Riesgo
8.
Eur J Surg Oncol ; 46(4 Pt A): 590-599, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31806520

RESUMEN

BACKGROUND: The peritoneal cancer index (PCI) calculated during exploratory laparotomy is a strong prognostic factor for overall survival (OS) in patients with colorectal peritoneal metastases (PM) who undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). Progression of the PCI between diagnostic laparoscopy (DLS) and potential CRS + HIPEC (ΔPCI) might be a more dynamic prognostic factor for OS after CRS + HIPEC. MATERIALS AND METHODS: Between 2012 and 2018, all colorectal PM patients who underwent an exploratory laparotomy for potential CRS + HIPEC after DLS were retrospectively identified from a prospectively maintained database. Patients were divided into stable disease (ΔPCI 0-3), mild progression (ΔPCI 4-9), or severe progression (ΔPCI ≥10). Kaplan-Meier analysis and a multivariate Cox regression were performed. RESULTS: Eighty-four patients (ΔPCI 0-3, n = 35; ΔPCI 4-9, n = 34; and ΔPCI ≥10, n = 15) were analysed. Median OS after CRS + HIPEC was significantly decreased in patients with a ΔPCI of 4-9 (35.1 [95% CI 25.5-44.6]) or ΔPCI ≥10 (24.1 [95% CI 11.7-36.5]) compared to patients with a ΔPCI of 0-3 (47.9 [95% CI 40.0-55.7], p = 0.004). In multivariate regression analysis, ΔPCI remained an independent risk factor for OS: ΔPCI 4-9 HR 3.1 (95% CI 1.4-7.2, p = 0.007) and ΔPCI ≥10 HR 4.4 (95% CI 1.5-13.1, p = 0.007). CONCLUSION: A high ΔPCI is an independent dynamic prognostic factor for OS and might reflect a more aggressive tumour biology in patients with colorectal PM. HIPEC surgeons should be aware of a high-ΔPCI-associated diminished prognosis and should reconsider CRS + HIPEC when confronted with a ΔPCI ≥10.


Asunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Carcinoma/secundario , Neoplasias Colorrectales/patología , Mitomicina/uso terapéutico , Neoplasias Peritoneales/secundario , Anciano , Carcinoma/terapia , Procedimientos Quirúrgicos de Citorreducción , Progresión de la Enfermedad , Femenino , Humanos , Hipertermia Inducida , Estimación de Kaplan-Meier , Laparotomía , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/terapia , Pronóstico , Modelos de Riesgos Proporcionales , Tasa de Supervivencia , Carga Tumoral
9.
Med Arch ; 73(5): 331-337, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31819307

RESUMEN

INTRODUCTION: Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC) has positive effects on the survival of patients with peritoneal carcinomatosis (PC) due to intra-abdominal tumors. Currently, the available literature on the safety of the Enhanced Recovery After Surgery (ERAS) protocol for PC, which is associated with severe morbidity and mortality, is insufficient. AIM: This study aimed to present our results from treating patients using the ERAS protocol for PC that developed due to intra-abdominal tumors. MATERIAL AND METHODS: The data of 120 consecutive patients with PC due to different etiologies of abdominal origin and who underwent CRS ± HIPEC were analyzed. The patients were divided into two groups according to whether the ERAS protocol was applied. Information on demographics, length of hospital stay, cost, morbidity, and mortality was statistically compared between groups. RESULTS: A total of 102 patients were included in the study. The first 40 patients did not undergo the ERAS protocol, whereas 62 patients did undergo the protocol. The mean length of hospital stay was 10 days in the non-ERAS group and 7 days in the ERAS group. The ERAS group was observed to have earlier mobilization, earlier gas and stool release, lower oral intake, and fewer respiratory problems than the non-ERAS group. CONCLUSION: CRS ± HIPEC has a positive effect on survival. The simultaneous application of the ERAS protocol with the aforementioned procedure has positive effects on intestinal motility and postoperative outcomes. In addition, this protocol may reduce costs by shortening the length of hospital stay.


Asunto(s)
Antineoplásicos/administración & dosificación , Carcinoma/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Recuperación Mejorada Después de la Cirugía , Hipertermia Inducida/métodos , Neoplasias Peritoneales/terapia , Sarcoma/terapia , Adulto , Anciano , Carcinoma/secundario , Neoplasias Colorrectales/patología , Ambulación Precoz , Femenino , Motilidad Gastrointestinal , Humanos , Infusiones Parenterales , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Peritoneales/secundario , Complicaciones Posoperatorias/epidemiología , Sarcoma/secundario , Neoplasias Gástricas/patología
10.
J Visc Surg ; 156(5): 377-379, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466831

RESUMEN

When peritoneal metastases are diagnosed (strong agreement of experts): (i) seek advice from a multidisciplinary coordination meeting (MCM) with large experience in peritoneal disease (e.g. BIG RENAPE network); (ii) transfer (or not) the patient to a referral center with experience in hyperthermic intraperitoneal chemotherapy (HIPEC), according to the advice of the MCM. With regard to systemic chemotherapy (strong agreement of experts): (i) it should be performed both before and after surgery, (ii) for no longer than 6 months; (iii) without postoperative anti-angiogenetic drugs. With regard to cytoreductive surgery (strong agreement of experts): (i) Radical surgery requires a xiphopubic midline incision; (ii) no cytoreductive surgery via laparoscopy. With regard to HIPEC: HIPEC can be proposed for trials outside an HIPEC referral center (weak agreement between experts): (i) if surgery is radical; (ii) if the expected morbidity is "reasonable"; (iii) if the indication for HIPEC was suggested by a MCM, and; (iv) mitomycin is preferred to oxaliplatin (which cannot be recommended) for this indication.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/secundario , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos de Citorreducción/métodos , Hipertermia Inducida/métodos , Neoplasias Peritoneales/secundario , Antineoplásicos/uso terapéutico , Carcinoma/terapia , Quimioterapia del Cáncer por Perfusión Regional/normas , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción/normas , Humanos , Hipertermia Inducida/normas , Neoplasias Peritoneales/terapia
11.
Ann Thorac Cardiovasc Surg ; 25(5): 253-259, 2019 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-31189775

RESUMEN

PURPOSE: To evaluate prognosis of patients with esophageal carcinoma undergoing pulmonary metastasectomy, and help determine appropriate therapeutic strategies. METHODS: We retrospectively studied 16 patients (15 men and one woman; median age 66.5 years) with esophageal carcinoma, who underwent curative resection of pulmonary metastases. Clinical characteristics and surgical outcomes were analyzed. RESULTS: In all, 11 patients underwent wedge resection, three segmentectomy, and two lobectomies. The average operating time and blood loss were 147 min and 103 mL, respectively. There were no perioperative deaths or severe complications. Five-year overall survival rate was 40.2% and 2-year disease-free survival rate was 35.2%. All recurrences occurred within 2 years. Univariate and multivariate analyses revealed that absence of adjuvant chemotherapy after therapy for esophageal carcinoma was a significant predictor of poor prognosis and recurrence, respectively (p <0.05). The prognosis of seven patients who underwent esophagectomy with adjuvant chemotherapy was better than that of the other nine patients (p = 0.0166). CONCLUSION: Pulmonary metastasectomy in patients with esophageal carcinoma was only one choice of multimodal treatment, and perioperative chemotherapy was important for long-term survival after pulmonary metastasectomy. Pulmonary metastasectomy was effective in patients undergoing esophagectomy with adjuvant chemotherapy.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/terapia , Neoplasias Esofágicas/terapia , Esofagectomía , Neoplasias Pulmonares/terapia , Metastasectomía/métodos , Neumonectomía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma/mortalidad , Carcinoma/secundario , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Esquema de Medicación , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Esofagectomía/mortalidad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Masculino , Metastasectomía/efectos adversos , Metastasectomía/mortalidad , Persona de Mediana Edad , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Supervivencia sin Progresión , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
12.
Eur J Surg Oncol ; 45(11): 2003-2008, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31217079

RESUMEN

Colorectal cancer (CRC) peritoneal metastasis (PM) is one of the most important cause of cancer-related death in world. CRC PM is considered as a homogeneous disease without differentiating colonic or rectal origin. Aim of this study is to analyze survival of patients treated with cytoreductive surgery and HIPEC, according to the origin of PM. Literature search was performed to identify relevant articles. All meta-analysis were performed using mean difference and log of HR, when appropriate. The I2 statistic was used to determine the heterogeneity of included studies. Out of 349 selected records, 9 articles (1308 patients, 1153 colon PM and 155 rectal PM) have been included. OS and DFS is higher in patients affected by colon PM (OS mean difference: 24,49 months [95% CI: 14,70-34,28 months, p < 0,000001]; DFS mean difference: 7,75 months [95% CI: 1,37-14,13 months, p: 0,02]) and pooled Hazard Ratio for disease-related death in rectal PM is 1.62 [95% CI: 1,01-2,59, p: 0,05] compared to colon PM). Heterogeneity among selected studies is high in two subgroups and low in one (OS subgroup A I2: 98%, p < 0,000001; DFS subgroup I2: 91%, p < 0,000001; OS subgroup B I2: 25%, p: 0,26). Our analysis, with all the limitations related to included studies, suggests that peritoneal metastasis of rectal tumors treated with CRS and HIPEC have a worst prognosis of colon tumors PM. Larger studies are required to confirm those results and therefore we invite all Authors in considering also tumor localization when reporting data on CRC peritoneal metastasis treatment.


Asunto(s)
Antineoplásicos/administración & dosificación , Carcinoma/terapia , Neoplasias del Colon/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Hipertermia Inducida/métodos , Neoplasias Peritoneales/terapia , Neoplasias del Recto/terapia , Carcinoma/secundario , Neoplasias del Colon/patología , Terapia Combinada , Supervivencia sin Enfermedad , Humanos , Infusiones Parenterales , Neoplasias Peritoneales/secundario , Pronóstico , Neoplasias del Recto/patología , Tasa de Supervivencia , Resultado del Tratamiento
14.
World Neurosurg ; 127: e172-e178, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30878742

RESUMEN

BACKGROUND: Brain metastases (BMs) are classically well-circumscribed lesions. Still, the amount of edema in these neoplasms suggests either mechanisms of infiltration or defense. A better understanding of the mechanisms within the edema of BMs seems reasonable to preoperatively identify areas of potential infiltration and resect them. BMs represent tumors with high energy demand and cell turnover; therefore, they qualify for preoperative investigation with phosphorus-31 magnetic resonance spectroscopy (31PMRS), which reveals information about those characteristics. METHODS: Ten patients with BMs were included in this trial. All underwent preoperative standard magnetic resonance imaging with additional 31PMRS. In all patients, 1 voxel within the contrast-enhancing tumor (CE+), 1 voxel at the border (including CE+ areas and surrounding T2-hyperintensive [T2+] areas), and 1 distant voxel purely including T2+ areas were determined by a neuroradiologist and a neurosurgeon. A frameless stereotactic biopsy was performed after craniotomy. Subsequently, the metabolites of the 31PMRS were analyzed and compared with the histopathologic results. RESULTS: Ratios, reflecting resynthesis (CE+/border/T2+: 1.109 ± 0.192/1.112 ± 0.158/1.083 ± 0.097), hydrolysis (0.303 ± 0.089/0.360 ± 0.122/0.321 ± 0.089), energy demand (4.227 ± 2.35/3.453 ± 1.284/3.599 ± 0.833), and membrane turnover (1.239 ± 0.2611/3.453 ± 1.284/3.599 ± 0.283) were calculated and compared intraindividually with a voxel from the contralateral side (resynthesis/hydrolysis/energy demand/membrane turnover: 1.063 ± 0.085/0.335 ± 0.073/3.317 ± 0.7573/0.784 ± 0.186), respectively. Resynthesis showed a trend toward higher ratios in CE+ and border biopsies without reaching statistical significances. This trend was also seen concerning energy demand. Membrane turnover was significantly higher in CE+, border zone, and also in the T2+ areas compared with controls (P > 0.001). CONCLUSIONS: 31PMRS in BMs provides information on metabolic changes in tumor and surrounding edema. There is proof of enhanced metabolism in tissue without histologic tumor manifestation.


Asunto(s)
Neoplasias Encefálicas/secundario , Espectroscopía de Resonancia Magnética/métodos , Adulto , Anciano , Biopsia/métodos , Edema Encefálico/etiología , Edema Encefálico/patología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patología , Carcinoma/metabolismo , Carcinoma/secundario , Craneotomía , Metabolismo Energético , Femenino , Humanos , Masculino , Melanoma/metabolismo , Melanoma/secundario , Persona de Mediana Edad , Invasividad Neoplásica , Fósforo , Estudios Prospectivos , Técnicas Estereotáxicas
15.
J Geriatr Oncol ; 10(4): 591-597, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30551958

RESUMEN

OBJECTIVES: Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. MATERIALS AND METHODS: Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. RESULTS: Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71-1.03, P = .102) and OS (HR 0.82, 95%CI 0.65-1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. CONCLUSION: In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.


Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Adulto , Factores de Edad , Anciano , Capecitabina/administración & dosificación , Capecitabina/uso terapéutico , Carcinoma/metabolismo , Carcinoma/patología , Carcinoma/secundario , Quimioterapia Adyuvante , Estudios de Cohortes , Progresión de la Enfermedad , Docetaxel/administración & dosificación , Docetaxel/uso terapéutico , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Irinotecán/administración & dosificación , Irinotecán/uso terapéutico , Italia , Estimación de Kaplan-Meier , L-Lactato Deshidrogenasa/metabolismo , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Paclitaxel/administración & dosificación , Paclitaxel/uso terapéutico , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Compuestos de Platino/administración & dosificación , Compuestos de Platino/uso terapéutico , Supervivencia sin Progresión , Modelos de Riesgos Proporcionales , Receptor ErbB-2/metabolismo , Estudios Retrospectivos , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patología , Insuficiencia del Tratamiento
17.
Kyobu Geka ; 71(7): 552-555, 2018 Jul.
Artículo en Japonés | MEDLINE | ID: mdl-30042260

RESUMEN

A 51-year-old woman underwent radical operation for a gastric cancer and adjuvant chemotherapy with tegafur, gimeracil, and oteracil potassium. Five and a half years later, screening chest computed tomography(CT)scan showed slight ground glass opacity(GGO)of the both lungs and they were regarded as inflammatory change. Several months later, she experienced a dry cough. CT scan showed aggravation of GGO, and she was refered to our hospital to investigate these lesions 6 years after operation. We performed a wedge resection of right middle lobe. A postoperative pathology revealed metastatic carcinomatous lymphangiosis of gastric cancer. Chemotherapy using capecitabine and oxaliplatin, and then docetaxel was performed and talc pleurodesis was done for the malignant pleural effusion. These treatments did not improve condition, and she died 7 months after lung operation. In conclusion, we need to consider GGO as the possibility of carcinomatous lymphangiosis in case of patient with gastric cancer.


Asunto(s)
Carcinoma/secundario , Neoplasias Pulmonares/secundario , Neoplasias Gástricas/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Capecitabina/administración & dosificación , Carcinoma/patología , Carcinoma/terapia , Quimioterapia Adyuvante , Docetaxel/administración & dosificación , Resultado Fatal , Femenino , Humanos , Neoplasias Pulmonares/terapia , Persona de Mediana Edad , Oxaliplatino/administración & dosificación , Ácido Oxónico/administración & dosificación , Piridinas/administración & dosificación , Neoplasias Gástricas/terapia , Tegafur/administración & dosificación , Tomografía Computarizada por Rayos X
18.
Eur J Surg Oncol ; 44(7): 1083-1086, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29699839

RESUMEN

BACKGROUND: The hepatic bridge forms a tunnel of liver parenchyma that may obscure peritoneal metastases associated with the round ligament. Visualization and then resection of nodules associated with this structure is necessary. MATERIALS AND METHODS: The incidence of a hepatic bridge and the extent that it covered the round ligament was determined in consecutive patients. Extent of coverage of the round ligament by the hepatic bridge was determined: Class 1 indicates up to one-third of the round ligament obscured, Class 2 up to two-thirds and Class 3 more than two-thirds. RESULTS: In 102 patients in whom the round ligament of the liver could be completely visualized, 50 had a hepatic bridge. Class 1 was 22 (44%) of the bridges, Class 2 was 16 (32%) and Class 3 was 12 (24%). A hepatic bridge was more frequently present in 28 of 45 male patients (62%) vs. 22 of 57 female patients (38%). CONCLUSIONS: Approximately one-half of our patients having cytoreductive surgery for peritoneal metastases were observed to have a hepatic bridge. Up to 56% of these patients have Class 2 or 3 hepatic bridge and may require division of the hepatic bridge to completely visualize the contents of the tunnel created by this structure.


Asunto(s)
Variación Anatómica , Carcinoma/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Neoplasias Peritoneales/terapia , Peritoneo/anatomía & histología , Ligamento Redondo del Hígado/anatomía & histología , Sarcoma/terapia , Antineoplásicos/administración & dosificación , Neoplasias del Apéndice/patología , Carcinoma/secundario , Neoplasias Colorrectales/patología , Femenino , Humanos , Hipertermia Inducida , Infusiones Parenterales , Hígado/anatomía & histología , Masculino , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Peritoneales/secundario , Sarcoma/secundario , Factores Sexuales
19.
Eur J Surg Oncol ; 44(7): 983-990, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29530346

RESUMEN

BACKGROUND: The aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases. METHODS: Patients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics. RESULTS: No statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700-31,200 GBP. CONCLUSION: The HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.


Asunto(s)
Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/terapia , Neoplasias Colorrectales/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Fluorouracilo/administración & dosificación , Hipertermia Inducida/métodos , Neoplasias Peritoneales/terapia , Calidad de Vida , Anciano , Antineoplásicos/economía , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Carcinoma/fisiopatología , Carcinoma/psicología , Carcinoma/secundario , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/fisiopatología , Neoplasias Colorrectales/psicología , Análisis Costo-Beneficio , Procedimientos Quirúrgicos de Citorreducción/economía , Femenino , Fluorouracilo/economía , Estado de Salud , Humanos , Hipertermia Inducida/economía , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/economía , Oxaliplatino , Neoplasias Peritoneales/fisiopatología , Neoplasias Peritoneales/psicología , Neoplasias Peritoneales/secundario , Años de Vida Ajustados por Calidad de Vida
20.
Psychosomatics ; 59(3): 251-258, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29525523

RESUMEN

BACKGROUND: Young adults with cancer experience disruptions in their normal developmental trajectories and commonly experience psychologic distress related to their diagnoses. Young women with metastatic breast cancer (MBC) are at particular risk of adverse mental health outcomes. OBJECTIVE: We sought to determine the prevalence of and factors associated with anxiety and depression symptoms in young women with newly diagnosed de novo MBC. METHODS: A total of 54 women with newly diagnosed de novo MBC were identified from an ongoing, prospective, multicenter cohort of women diagnosed with breast cancer at age <40. Depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Items assessing socio-demographics, physical symptom burden, social support, and disease and treatment history, with complementary medical record review, were used to assess variables potentially associated with anxiety and depression symptoms. RESULTS: Mean HADS Depression score was 4.4 (standard deviation = 3.7) and mean HADS Anxiety score was 7.9 (standard deviation = 5.0). Eleven (20%) women scored ≥8 on the HADS Depression subscale, the suggested threshold for depression/anxiety screening, and 24 (44%) women scored ≥8 on the HADS Anxiety subscale. In a multivariable model of anxiety, higher physical symptom scores (odds ratio = 4.41, p = 0.005) was significantly associated with higher anxiety scores. None of the other variables improved the model fit. CONCLUSION: In this study, a considerable proportion of young women with newly diagnosed MBC experienced anxiety symptoms, although depression was less common. Future strategies focused on distress reduction in young MBC patients should focus on physical symptom management as well as anxiety identification and management.


Asunto(s)
Ansiedad/epidemiología , Neoplasias de la Mama/epidemiología , Carcinoma/epidemiología , Depresión/epidemiología , Adulto , Ansiedad/psicología , Neoplasias de la Mama/patología , Neoplasias de la Mama/psicología , Carcinoma/psicología , Carcinoma/secundario , Costo de Enfermedad , Estudios Transversales , Depresión/psicología , Escolaridad , Femenino , Humanos , Modelos Logísticos , Modelos Psicológicos , Análisis Multivariante , Metástasis de la Neoplasia , Prevalencia , Clase Social , Apoyo Social , Espiritualidad , Adulto Joven
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