RESUMO
BACKGROUND: Microsatellite studies in histologic types B3 and C thymic neoplasia detected gains on chromosome 17q, which contains the Her-2/neu and its juxtaposed topoisomerase 2alpha (T2alpha) genes. The study aimed to evaluate their impact on tumor biology and survival of advanced thymic neoplasia patients. METHODS: From 1991 to 2005, 36 consecutive stage IV thymic carcinoma patients were treated, 18 men and 18 women, aged 11 to 84 years. There were 22 thymic carcinoma, 13 type B3, and 1 type B2 thymoma. Patients received treatment consisting of surgical resection, combination chemotherapy with the CAP (cyclophosphamide, Adriamycin, cisplatin) regimen, or radiation therapy potentiated by high-dose weekly 5-fluorouracil infusion. Permutations of these 3 treatment modalities were prescribed as necessary. RESULTS: T2alpha gene amplification was detected in 4 of 14 thymic carcinoma and 1 of 15 type B3 thymoma. Three thymic carcinoma patients had Her-2/neu coamplification and these 3 patients had rapidly growing tumor and extensive disease at initial diagnosis. CAP was prescribed in 28 patients and 20 patients responded (response rate, 71.4%, 95% confidence interval [CI]: 52.8% to 85%); all responders overexpressed (> or = 10% nuclei positive) the T2alpha protein, whereas 4 nonresponders had very low expression. T2alpha overexpression predicts CAP response, and its absence predicts resistance (P = .001). Overall survival was significantly prolonged if the tumor was resectable (P = .001), of type B3 histology (P = .0039), and had no Her-2 gene amplification (P = .0081). CONCLUSION: T2alpha and Her-2/neu genes play a pivotal role in the tumor biology, CAP response, and survival of advanced thymic neoplasia patients.
Assuntos
Antígenos de Neoplasias/fisiologia , DNA Topoisomerases Tipo II/fisiologia , Proteínas de Ligação a DNA/fisiologia , Neoplasias do Timo/enzimologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Cromossomos Humanos Par 17/genética , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Amplificação de Genes , Genes erbB-2/fisiologia , Humanos , Técnicas Imunoenzimáticas , Hibridização in Situ Fluorescente , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor ErbB-2/genética , Taxa de Sobrevida , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/radioterapiaRESUMO
Afferent loop syndrome (ALS) is a debilitating complication of recurrent gastric cancer. Surgical intervention is usually not feasible in the face of poor general performance, presence of advanced peritoneal carcinomatosis and limited survival of the patients. Non-surgical approaches include internal drainage by stenting at the stenotic or anastomotic site and external drainage via the percutaneous routes. Percutaneous transhepatic duodenal drainage (PTDD) has been shown to provide effective palliation for ALS, but long-term catheterization is usually inevitable. We hereby present two cases of recurrent gastric cancer whose ALS was successfully treated with PTDD followed by weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin (HDFL). PTDD rapidly ameliorated the incapacitating symptoms of ALS, and the effective, low-toxicity chemotherapy subsequently led to tumor regression, restoration of bowel patency and removal of the drainage tube. At present, both patients have remained ALS-free and drainage-free for 16 and 17 months, respectively. Our results indicate that this non-surgical approach with PTDD followed by weekly HDFL could serve as a safe and effective treatment for ALS in recurrent gastric cancer complicated by peritoneal carcinomatosis.
Assuntos
Síndrome da Alça Aferente/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma/terapia , Recidiva Local de Neoplasia/terapia , Cuidados Paliativos , Doenças Peritoneais/terapia , Neoplasias Peritoneais/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Síndrome da Alça Aferente/diagnóstico , Síndrome da Alça Aferente/etiologia , Idoso , Carcinoma/diagnóstico , Carcinoma/etiologia , Terapia Combinada , Relação Dose-Resposta a Droga , Drenagem/métodos , Fluoruracila/administração & dosagem , Seguimentos , Gastrectomia/métodos , Humanos , Infusões Intravenosas , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/etiologia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/etiologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
Respiratory failure and conscious disturbance developed in a 18-month-old girl following ingestion of an unknown quantity of spot remover solution, a petroleum distillate product. Rapid deterioration was noted within 2 hours after ingestion. The patient became stable in condition and dramatically improved through intensive care with respiratory support by using nasal prongs continuous positive airway pressure (NPCPAP). To our knowledge, this may be the first case being successfully managed with this technique.