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1.
Arch Ital Urol Androl ; 92(2)2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32597103

RESUMO

COVID-19 pandemic strongly modified the organizations of our clinical practice. Strict containment measures have been adopted to limit the disease diffusion. In particular, hospital face-to-face post discharge and follow up visits have been reduced. Although cancelling or deferring appointments seems to be a pragmatic approach, this solution may have a devasting long-term impact on health medical care and on patients. In this context, telemedicine and remote consultations may have the potential to provide healthcare minimizing virus exposure. In this paper we describe how Multidisciplinary team (MDT) reorganized genitourinary cancer care delivery at our Institute (AO SS Antonio e Biagio e Cesare Arrigo, Alessandria), taking advantage of telematic means. Furthermore, we present our preliminary results regarding patients' satisfaction.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral , Neoplasias Urogenitais/terapia , Urologia/métodos , Assistência ao Convalescente/métodos , Agendamento de Consultas , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Medicina , Visita a Consultório Médico , Enfermagem Oncológica , Pandemias/prevenção & controle , Satisfação do Paciente , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Telefone , Neoplasias Urogenitais/psicologia , Neoplasias Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos
2.
Int Braz J Urol ; 46(suppl.1): 98-103, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32549077

RESUMO

PURPOSE: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. MATERIAL AND METHODS: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. RESULTS: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. CONCLUSIONS: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neoplasias Urogenitais/terapia , Betacoronavirus , Humanos , Oncologia/métodos , Pandemias , Assistência ao Paciente
4.
Eur Urol ; 78(1): 29-42, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414626

RESUMO

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of many urologic cancers. OBJECTIVE: To provide a contemporary picture of the risks from delayed treatment for urologic cancers to assist with triage. EVIDENCE ACQUISITION: A collaborative review using literature published as of April 2, 2020. EVIDENCE SYNTHESIS: Patients with low-grade non-muscle-invasive bladder cancer are unlikely to suffer from a 3-6-month delay. Patients with muscle-invasive bladder cancer are at risk of disease progression, with radical cystectomy delays beyond 12 wk from diagnosis or completion of neoadjuvant chemotherapy. Prioritization of these patients for surgery or management with radiochemotherapy is encouraged. Active surveillance should be used for low-risk prostate cancer (PCa). Treatment of most patients with intermediate- and high-risk PCa can be deferred 3-6 mo without change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant androgen deprivation therapy (ADT) is the standard of care. For surgery, although the added value of neoadjuvant ADT is questionable, it may be considered if a patient is interested in such an approach. Intervention may be safely deferred for T1/T2 renal masses, while locally advanced renal tumors (≥T3) should be treated expeditiously. Patients with metastatic renal cancer may consider vascular endothelial growth factor targeted therapy over immunotherapy. Risks for delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 wk in nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile cancer, adverse outcomes have been observed with delays of ≥3 mo before inguinal lymphadenectomy. Limitations include a paucity of data and methodologic variations for many cancers. CONCLUSIONS: Patients and clinicians should consider the oncologic risk of delayed cancer intervention versus the risks of COVID-19 to the patient, treating health care professionals, and the health care system. PATIENT SUMMARY: The coronavirus disease 2019 pandemic has led to delays in the treatment of patients with urologic malignancies. Based on a review of the literature, patients with high-grade urothelial carcinoma, advanced kidney cancer, testicular cancer, and penile cancer should be prioritized for treatment during these challenging times.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Pandemias , Pneumonia Viral/complicações , Tempo para o Tratamento/organização & administração , Triagem/organização & administração , Neoplasias Urogenitais/terapia , Terapia Combinada/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Fatores de Risco , Neoplasias Urogenitais/complicações , Neoplasias Urogenitais/diagnóstico
5.
Indian J Cancer ; 57(2): 129-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32445315

RESUMO

The Corona Virus Disease-2019 (COVID-19), one of the most devastating pandemics ever, has left thousands of cancer patients to their fate. The future course of this pandemic is still an enigma, but health care services are expected to resume soon in a phased manner. This might be a long drawn process and we need to have policies in place, to be able to fight both, the SARS-CoV-2 virus and cancer, simultaneously, and emerge triumphant. An extensive literature search for impact of delay in management of various urological malignancies was carried out. Expert opinions were sought wherever there was paucity of evidence, in order to reach a consensus and come up with recommendations for directing uro-oncology services in the times of COVID-19. The panel recommends deferring treatment of patients with renal cell carcinoma by 3 to 6 months, except for those with ongoing hematuria and/or inferior vena cava thrombus, which warrant immediate surgery. Metastatic renal cell cancers should be started on targeted therapy. Low grade non-muscle invasive bladder cancers can be kept on active surveillance while high risk non-muscle invasive bladder cancers and muscle invasive bladder cancers should be treated within 3 months. Neoadjuvant chemotherapy should be avoided. Management of low and intermediate risk prostate cancer can be deferred for 3 to 6months while high risk prostate cancer patients can be initiated on neoadjuvant androgen deprivation therapy. Patients with testicular tumors should undergo high inguinal orchiectomy and be treated according to stage without delay, with stage I patients being offered surveillance. Penile cancers should undergo penectomy, while clinically negative groins can be kept on surveillance. Neoadjuvant chemotherapy should be avoided and adjuvant therapy should be deferred. We need to tailor our treatment strategies to the prevailing present conditions, so as to fight and defeat both, the SARS-CoV-2 virus and cancer. Protection of health care workers, judicious use of available resources, and a rational and balanced outlook towards different malignancies is the need of the hour.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias Renais/terapia , Pneumonia Viral/epidemiologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urogenitais/terapia , Carcinoma de Células Renais , Infecções por Coronavirus/prevenção & controle , Humanos , Índia/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Oncologia/métodos , Oncologia/normas , Pandemias/prevenção & controle , Neoplasias Penianas/terapia , Pneumonia Viral/prevenção & controle , Neoplasias da Próstata/terapia , Neoplasias Testiculares/terapia
8.
Prog Urol ; 30(5): 221-231, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32224294

RESUMO

AIM: The French population is facing the COVID-19 pandemic and the health system have been reoriented in emergency for the care of patients with coronavirus. The management of cancers of the urinary and male genital tracts must be adapted to this context. MATERIAL AND METHOD: An expert opinion documented by a literature review was formulated by the Cancerology Committee of the French Association of Urology (CCAFU). RESULTS: The medical and surgical management of patients with any cancers of the urinary and male genital tracts must be adapted by modifying the consultation methods, by prioritizing interventions according to the intrinsic prognosis of cancers, taking into account the patient's comorbidities. The protection of urologists from COVID-19 must be considered. CONCLUSION: The CCAFU issues an expert opinion on the measure to be taken to adapt the management of cancers of the male urinary and genital tract to the context of pandemic by COVID-19.


Assuntos
Infecções por Coronavirus , Gerenciamento Clínico , Controle de Infecções , Pandemias , Pneumonia Viral , Neoplasias Urogenitais/cirurgia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Epidemias , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pneumonia Viral/epidemiologia , Sociedades Médicas , Urologistas
9.
Urologe A ; 59(6): 695-699, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32270244

RESUMO

Modern concepts such as patient empowerment stand for the selection of appropriate concomitant treatment procedures from a scientific point of view and for placing these in the hands of the patient, thereby demanding and encouraging personal responsibility. It is important to distinguish between the terms complementary and/or alternative medicine. If we look at the motivation of patients to use complementary and/or alternative procedures, this is divided into the desire to do something directly against the tumor and on the other hand to strengthen the body's own resources, support the immune system, and reduce side effects in a concrete manner. The crux of modern oncology is that many specialists no longer have sufficient time for detailed patient information talks and multiple good physician-patient talks. The importance of complementary medicine in addition to nutrition and exercise lies above all in its targeted use as a concomitant supportive therapy. Complementary medicine primarily offers the chance to meet the desire of those affected to actively participate in their treatment.


Assuntos
Terapias Complementares/métodos , Neoplasias Urogenitais/terapia , Humanos , Oncologia/tendências , Participação do Paciente , Relações Médico-Paciente
10.
Adv Exp Med Biol ; 1244: 107-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32301013

RESUMO

The past decade has witnessed a revolution of immune checkpoint inhibitors in the treatment of multiple tumor types, including genitourinary cancers. Immune checkpoint inhibitors improved the treatment outcomes of patients with metastatic renal cell carcinoma and metastatic urothelial carcinoma. In prostate cancer, the role of immunotherapy with checkpoint inhibitors is not yet established, but clinical trials investigating their use are ongoing. Other immunotherapeutic approaches that have been explored in these malignancies include cytokines, vaccines, and cellular therapy. Ongoing studies are exploring the use of immunotherapy combinations as well as combination with chemotherapy and targeted therapy in these types of tumors. The use of immunotherapy beyond the metastatic setting is an active area of research. Moreover, there is a great interest in biomarker development to predict response to immunotherapy and risk of toxicity. This chapter is a comprehensive review of the immunotherapeutic approaches, both approved and investigational, for the treatment of renal cell carcinoma, urothelial carcinoma, and prostate cancer.


Assuntos
Imunoterapia , Neoplasias Urogenitais/terapia , Antígeno B7-H1/antagonistas & inibidores , Carcinoma de Células Renais/imunologia , Carcinoma de Células Renais/terapia , Humanos , Neoplasias Renais/imunologia , Neoplasias Renais/terapia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Neoplasias Urogenitais/imunologia
11.
Asian Pac J Cancer Prev ; 21(3): 761-770, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32212805

RESUMO

OBJECTIVE: To evaluate the efficacy of postoperative gum-chewing compare with routine postoperative care on the recovery of gastrointestinal function after comprehensive surgical staging for gynecological cancer. MATERIALS AND METHODS: A total of 82 patients who underwent comprehensive surgical staging for gynecological cancer at Rajavithi Hospital between October 1st, 2018 and June 30th, 2019 were randomly allocated into two groups: Gum-chewing group (n=40) and control group (n=42). In the gum-chewing group, patients were assigned to chew sugar-free gum for 30 minutes starting from the first postoperative morning then every 8 hours until the first passage of flatus. In the control group, patients have received routine postoperative care. The primary endpoint was time to first flatus after surgery. The secondary endpoints were time to first bowel sound, time to first defecation, time to first walk, postoperative analgesia and anti-emetic drug requirement, ileus symptoms, length of a hospital stay, and potential adverse events of gum-chewing, including dry mount, choking, and aspiration. RESULT: Chewing gum was statistically significant in reducing time to first flatus compared with routine postoperative care (median 24.7 (range 2.2-86.5) vs 35.4 (range 7.2-80.9) hours, p=0.025). The length of a hospital stay was also significantly shorter in the gum-chewing group (median 3.0 (range 1.0-8.8) vs 3.5 (range 1.8-50.0) days, p=0.023). There were no significant differences in time to first bowel sound, time to first defecation, time to first walk, postoperative analgesia and anti-emetic drug requirement, and ileus symptoms between both two groups. No adverse events related to postoperative gum-chewing were observed. CONCLUSION: Gum-chewing was associated with early recovery of gastrointestinal function in patients undergoing surgery for gynecological cancer. It is an inexpensive and physiologic intervention that appears to be reasonably safe and should be recommended as an adjunct in postoperative care of gynecological cancer surgery.


Assuntos
Goma de Mascar , Neoplasias Urogenitais , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia , Hospitais , Humanos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Neoplasias Urogenitais/cirurgia , Neoplasias Uterinas
12.
Arch Pathol Lab Med ; 144(3): 305-319, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32101056

RESUMO

CONTEXT.­: The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual changed the tumor, node, metastasis (TNM) classification systems of genitourinary malignancies in 2017. However, some of the changes appear not well appreciated or recognized by practicing pathologists. OBJECTIVE.­: To review the major changes compared with the 7th edition in cancers of the prostate, penis, testis, bladder, urethra, renal pelvis/ureter, and kidney and discuss the challenges that pathologists may encounter. DATA SOURCES.­: Peer-reviewed publications and the 8th and 7th editions of the AJCC Cancer Staging Manual. CONCLUSIONS.­: This article summarizes the updated staging of genitourinary malignancies, specifically highlighting changes from the 7th edition that are relevant to the pathologic staging system. Pathologists should be aware of the updates made in hopes of providing clarification and the remaining diagnostic challenges associated with these changes.


Assuntos
Neoplasias Renais/patologia , Estadiamento de Neoplasias/métodos , Neoplasias da Próstata/patologia , Neoplasias Uretrais/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias Urogenitais/patologia , Feminino , Humanos , Neoplasias Renais/diagnóstico , Metástase Linfática , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias Uretrais/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias Urogenitais/diagnóstico
13.
Arch Pathol Lab Med ; 144(3): 290-304, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32101059

RESUMO

CONTEXT.­: Immunohistochemistry (IHC) has become increasingly important in the evaluation of pathologic conditions in the genitourinary (GU) organs. In addition to careful evaluation of hematoxylin-eosin sections and generation of a differential diagnosis, choosing the optimal panel of IHC markers becomes even more important when the biopsy material is very limited. The following summary of our experience supplemented with relevant literature review exemplifies how to use IHC to facilitate pathologic diagnosis in the GU system. OBJECTIVE.­: To describe our experience with the most common immunohistochemical markers used in GU pathology. DATA SOURCES.­: Institutional experience and literature search comprise our data sources. CONCLUSIONS.­: Application of IHC provides enormous benefits to the interpretation of GU pathologic conditions, including benign and malignant lesions. However, both insufficient and excessive types of use of IHC, as well as incorrect interpretations in common and rare GU conditions, could present pitfalls in diagnosis.


Assuntos
Biomarcadores Tumorais/biossíntese , Imuno-Histoquímica/métodos , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias da Próstata/diagnóstico , Neoplasias Testiculares/diagnóstico , Neoplasias Urogenitais/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/metabolismo , Neoplasias da Próstata/metabolismo , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias Testiculares/metabolismo , Neoplasias Urogenitais/metabolismo
15.
Int J Radiat Oncol Biol Phys ; 106(1): 37-42, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31229573

RESUMO

PURPOSE: We sought to characterize temporal trends of radiation oncology resident-reported external beam radiation therapy (EBRT) case experience with respect to various disease sites, including trends in stereotactic radiosurgery and stereotactic body radiation therapy cases. METHODS AND MATERIALS: Summarized, deidentified case logs for graduating radiation oncology residents between 2007 and 2018 were obtained from the Accreditation Council for Graduate Medical Education national summary data report. Mean number of cumulative cases and standard deviations per graduating resident by year were evaluated. Cases were subdivided into 12 disease-site categories using the Accreditation Council for Graduate Medical Education classification. Analysis of variance was used to determine significant differences, and strength of association was evaluated using Pearson correlation. RESULTS: The number of graduating residents per year increased by 66% from 114 in 2007 to 189 in 2018 (P < .001, r = 0.88). The overall mean number of EBRT cases per graduating resident decreased by 13.2% from 521.9 in 2007 to 478.5 in 2018, with a decrease in the ratio of nonmetastatic to metastatic cases per graduating resident. There was significant variation among the disease categories analyzed; however, the largest proportionate decreases were seen in hematologic, lung, and genitourinary malignancies. Stereotactic radiosurgery volume per graduating resident increased from an average of 27.9 cases in 2007 to 50.3 in 2018 (P < .001, r = 0.96). Stereotactic body radiation therapy volume per graduating resident increased as well, from a mean of 6 cases in 2007 to 55.6 cases in 2018 (P < .001, r = 0.99). CONCLUSIONS: We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.


Assuntos
Internato e Residência/tendências , Neoplasias/radioterapia , Radioterapia (Especialidade)/tendências , Carga de Trabalho , Análise de Variância , Competência Clínica , Neoplasias Hematológicas/radioterapia , Humanos , Internato e Residência/estatística & dados numéricos , Estudos Longitudinais , Neoplasias Pulmonares/radioterapia , Metástase Neoplásica/radioterapia , Neoplasias/classificação , Radioterapia (Especialidade)/estatística & dados numéricos , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/tendências , Radioterapia/estatística & dados numéricos , Radioterapia/tendências , Estudos Retrospectivos , Fatores de Tempo , Neoplasias Urogenitais/radioterapia , Carga de Trabalho/estatística & dados numéricos
16.
Cells ; 8(12)2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31842336

RESUMO

Genitourinary cancers (GCs) include a large group of different types of tumors localizing to the kidney, bladder, prostate, testis, and penis. Despite highly divergent molecular patterns, most GCs share commonly disturbed signaling pathways that involve the activity of TGF-ß (transforming growth factor beta). TGF-ß is a pleiotropic cytokine that regulates key cancer-related molecular and cellular processes, including proliferation, migration, invasion, apoptosis, and chemoresistance. The understanding of the mechanisms of TGF-ß actions in cancer is hindered by the "TGF-ß paradox" in which early stages of cancerogenic process are suppressed by TGF-ß while advanced stages are stimulated by its activity. A growing body of evidence suggests that these paradoxical TGF-ß actions could result from the interplay with microRNAs: Short, non-coding RNAs that regulate gene expression by binding to target transcripts and inducing mRNA degradation or inhibition of translation. Here, we discuss the current knowledge of TGF-ß signaling in GCs. Importantly, TGF-ß signaling and microRNA-mediated regulation of gene expression often act in complicated feedback circuits that involve other crucial regulators of cancer progression (e.g., androgen receptor). Furthermore, recently published in vitro and in vivo studies clearly indicate that the interplay between microRNAs and the TGF-ß signaling pathway offers new potential treatment options for GC patients.


Assuntos
MicroRNAs/genética , Fator de Crescimento Transformador beta/metabolismo , Neoplasias Urogenitais/patologia , Regulação Neoplásica da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Masculino , Prognóstico , Transdução de Sinais , Neoplasias Urogenitais/genética , Neoplasias Urogenitais/metabolismo
17.
Future Oncol ; 15(34): 3977-3986, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31724885

RESUMO

Background: Mucosal melanomas (MM) arise within the lining of the gastrointestinal (GI), genitourinary (GU) and head and neck (HN) systems. Method: A retrospective analysis of the National Comprehensive Database identified 4,961 MM patients. Primary objective was to compare survival outcomes across the different locations. Results: Overall survival for GI melanomas was significantly shorter than HN and GU melanomas. Median survival (95% confidence interval) was 19.5 (18.0-21.5), 26.4 (24.9-28.3), and 43.9 (38.8-47.8), months for GI, HN and GU cases, respectively (p<0.0001). Conclusion: This is the largest study of MM in a US based population, demonstrating worse overall survival for GI MM in comparison to HN and GU melanomas.


Assuntos
Neoplasias Gastrointestinais/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Melanoma/mortalidade , Membrana Mucosa/patologia , Neoplasias Urogenitais/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Melanoma/patologia , Melanoma/terapia , Pessoa de Meia-Idade , Fatores Sexuais , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia , Neoplasias Urogenitais/patologia , Neoplasias Urogenitais/terapia
18.
Arch Esp Urol ; 72(9): 972-974, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697260

RESUMO

OBJECTIVE: To show and report two new cases of urological cutaneous metastasis. METHODS: We describe two skin metastases cases. The first patient corresponds to a renal tumor and the other to a urothelial tumor. RESULTS: 52-year-old female with stage IV renal tumor,which is treated with Sunitinib. 34 months later, she refers ajaw angle skin ulcer, considered metastasis.75-year-old male with stage IV mixed urothelial carcinoma,which is treated with cystoprostatectomy and adjuvantchemotherapy. 9 months later, he showed 5 skin lesionsin his thorax. A core biopsy was diagnostic of urothelialcutaneous metastases. CONCLUSIONS: Genitourinary skin metastasis are rareand have poor prognosis. The largest incidence is in renaltumors, followed by bladder and prostate malignancies.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Cutâneas , Neoplasias Urogenitais , Idoso , Carcinoma de Células de Transição/secundário , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/secundário , Neoplasias Urogenitais/patologia
19.
J Cancer Res Clin Oncol ; 145(12): 3021-3036, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617075

RESUMO

PURPOSE: In recent years, immune checkpoint blockade (ICB) therapies have shown good clinical responses in various solid cancers. However, a major challenge in the process of ICB treatment is when tumors do not have enough infiltrating T cells. Antiangiogenic drugs targeting vascular endothelial growth factor (VEGF) and its receptors have been approved for the treatment of various malignant solid tumors alone or in combination with other therapies. Our review mainly discusses the preclinical rationale and clinical efficacy of antiangiogenic and ICB combination therapy in urogenital tumors. METHODS: We reviewed relevant literature on preclinical research and clinical trial results regarding antiangiogenic and ICB combination therapy in urogenital tumors from PubMed. In addition, we searched ongoing clinical trials on ClinicalTrials.gov to collect information related to this specific topic. RESULTS: Antiangiogenesis therapy could enhance T cell recruitment and increase T cell infiltration into the tumor microenvironment by blocking VEGF-VEGF receptor 2 binding and downstream signaling pathways to normalize tumor blood vessels. The combination of ICB and antiangiogenesis therapy could improve antitumor activity according to subsequent preclinical experiments and several phase I/II/III clinical trials on urogenital tumors. CONCLUSION: Combined therapy has shown some antitumor efficacy in several urogenital tumors, such as metastatic renal cell carcinoma, metastatic urothelial and genitourinary tumors, endometrial carcinoma, ovarian cancer, and fallopian tube cancer. Combination therapy is a promising strategy that can be used to improve the therapeutic efficacy, and the identification of precise biomarkers of this combined therapy is the direction of future studies.


Assuntos
Inibidores da Angiogênese/farmacologia , Inibidores da Angiogênese/uso terapêutico , Neoplasias Urogenitais/tratamento farmacológico , Animais , Ensaios Clínicos como Assunto , Terapia Combinada/métodos , Humanos , Imunoterapia/métodos , Linfócitos T/efeitos dos fármacos , Microambiente Tumoral/efeitos dos fármacos
20.
Zhonghua Er Ke Za Zhi ; 57(10): 767-773, 2019 Oct 02.
Artigo em Chinês | MEDLINE | ID: mdl-31594063

RESUMO

Objective: To summarize the clinical characteristics, treatment response and prognostic factors of rhabdomyosarcoma (RMS) in children. Methods: The clinical characteristics such as age at diagnosis, primary tumor site, tumor size, pathological type, clinical stage, and risk grouping of 213 RMS patients (140 males and 73 females) treated in Hematology Oncology Center of Beijing Children's Hospital, Capital Medical University, from May 2006 to June 2018 were analyzed retrospectively. The clinical characteristics, overall survival (OS), event free survival (EFS) and prognostic factors of children treated with the Beijing Children's Hospital-Rhabdomyosarcoma (BCH-RMS) regimen were analyzed. Survival data were analyzed by Kaplan-Meier survival analysis, and single factor analysis was performed by Log-Rank test. Results: The diagnostic age of 213 cases was 48.0 months (ranged 3.0-187.5 months), of which 136 cases (63.8%) were younger than 10 years old. The head and neck region was the most common primary site of tumor (30%, 64 cases), followed by the genitourinary tract (26.8%, 57 cases). Among pathological subtypes, embryonal RMS accounted for 71.4% (152 cases), while alveolar RMS and anaplastic RMS accounted for only 26.8% (57 cases) and 1.9% (4 cases), respectively. According to the Intergroup Rhabdomyosarcoma Study Group (IRS), IRS-Ⅲ and Ⅳ accounted for 85.0% (181 cases) of all RMS patients. In all patients, 9.4% (20 cases) patients were divided in to low-risk group, 52.1% (111 cases) patients in to intermediate -risk group, 25.8% (55 cases) patients in to high-risk group, and 12.7% (27 cases) patients in to the central nervous system invasion group, respectively. All patients with RMS received chemotherapy. The cycles of chemotherapy were 13.5 (ranged 5.0-18.0) for patients without event occurrence, while 14.2 (ranged 3.0-30.0) for patients with event occurrence. Among the 213 patients, 200 patients had surgical operation, of whom 103 patients underwent surgery before chemotherapy and 97 patients at the end of chemotherapy, 21 patients had secondary surgical resection. Radiotherapy was performed in 114 patients. The follow-up time was 23.0 months (ranged 0.5-151.0 months) . There were 98 patients with relapsed or progressed disease and 67 patients with death. The median time to progression was 10 months, of which 67 (68.4%) relapse occurred within 1 year and no recurrence occurred after follow-up for more than 5 years. The 3-year EFS and 5-year EFS were (52±4) % and (48±4) %, while the 3-year OS and 5-year OS were (65±4) % and (64±4) % by survival analysis. The 5-year OS of the low-risk, intermediate-risk, the high-risk were 100%, (74±5) %, (48±8) %, and the 2-year OS of the central nervous system invasion group was (36±11) % (χ(2)=33.52, P<0.01). The 5-year EFS of the low-risk, intermediate-risk, the high-risk were (93±6) %, (51±5) %, (36±7) % and the 2-year EFS of the central nervous system invasion group was (31±10) % (χ(2)=24.73, P<0.01) . Survival factor analysis suggested that the OS of children was correlated with age(χ(2)=4.16, P=0.038), tumor TNM stage (χ(2)=22.02, P=0.001), IRS group (χ(2)=4.49, P<0.01) and the risk group (χ(2)=33.52, P<0.01). Conclusions: This study showed that the median age of newly diagnosed RMS patients was 4 years. The head and neck and the genitourinary tract were the most common primary origin of RMS. The OS was low in single-center RMS children. The median time to recurrence was 10 months, and recurrence was rare 3 years later.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Rabdomiossarcoma/diagnóstico , Rabdomiossarcoma/terapia , Neoplasias Urogenitais/diagnóstico , Neoplasias Urogenitais/terapia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Retrospectivos , Rabdomiossarcoma/mortalidade , Rabdomiossarcoma/patologia , Rabdomiossarcoma Alveolar , Rabdomiossarcoma Embrionário , Análise de Sobrevida , Neoplasias Urogenitais/mortalidade , Neoplasias Urogenitais/patologia
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