RESUMEN
PURPOSE: This randomized phase III study compared bendamustine and prednisone (BP) to standard melphalan and prednisone (MP) treatment in previously untreated patients with multiple Myeloma (MM). PATIENTS AND METHODS: To be included, patients had to have histologically and cytologically proven stage II with progressive diseases or stage III MM. They were randomly assigned to receive BP (n=68) or MP (n=63). The primary endpoint was the time to treatment failure (TTF). Secondary endpoints included survival, remission rate, toxicity and quality of life. RESULTS: The overall response rate was 75% in the BP and 70% in the MP group. A significantly higher number of patients treated with BP achieved a complete remission than did patients receiving MP (32 vs. 13%; P=0.007), and the maximum response was achieved more rapidly in patients treated with BP compared to those receiving MP (6.8 vs. 8.7 cycles; P<0.02). TTF and remission duration were significantly longer in the BP group. Patients receiving BP had higher QoL scores and reported pain less frequently than patients receiving MP. CONCLUSION: BP is superior to MP with respect to complete remission rate, TTF, cycles needed to achieve maximum remission and quality of life and should be considered the new standard in first-line treatment of MM patients not eligible for transplantation.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Melfalán/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Compuestos de Mostaza Nitrogenada/administración & dosificación , Prednisona/administración & dosificación , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Clorhidrato de Bendamustina , Supervivencia sin Enfermedad , Femenino , Alemania Oriental , Humanos , Masculino , Melfalán/efectos adversos , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Mieloma Múltiple/patología , Compuestos de Mostaza Nitrogenada/efectos adversos , Prednisona/efectos adversos , Inducción de Remisión , Análisis de Supervivencia , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
We report the case of a 3-year-old boy with a Wilms' tumour of unfavourable histology with metastatic spread to the right testis. Orchiectomy and chemotherapy led to disease-free survival for more than 8 years.
Asunto(s)
Neoplasias Renales/patología , Neoplasias Testiculares/secundario , Tumor de Wilms/secundario , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Preescolar , Supervivencia sin Enfermedad , Humanos , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/radioterapia , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Orquiectomía , Radioterapia Adyuvante , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/cirugía , Tumor de Wilms/tratamiento farmacológico , Tumor de Wilms/radioterapia , Tumor de Wilms/cirugíaRESUMEN
INTRODUCTION: In the last few years the use of intraoperative electrophysiological monitoring of the recurrent laryngeal nerve (RLN) in thyroid gland surgery has become more and more important. PATIENTS AND METHOD: In a prospective study 223 nerves at risk in 116 patients were monitored with the Neurosign(R)100 (Fa. Magstim Ltd., UK). We used intramuscular needle electrodes inserted into the vocal muscle through the conic ligament. Practicability, complications, acceptance and predictive value of the method were documented. Recurrent nerve palsy rate and complications were compared with a control group operated upon without monitoring. RESULTS: The intraoperative delay using this method was on average 8.9 minutes. There were problems with monitoring equipment avoiding use in 6.4 %. In 2 cases (1.7 %) an accidental lesion of endotracheal tube cuff was found related to malpositioning of the needle and in 7.7 % a hematoma of the vocal cords was observed. 73.3 % of the surgeons accepted the method to identify and control the nerve integrity. False-positive and false-negative signals may occur. In cases of a final real stimulus response a regular vocal cord motility was found in 95 %. If a nerve conduction block was noted an immobility of ipsilateral vocal cord was diagnosed postoperatively in 50 %. There was no decrease in transient recurrent palsy rate using monitoring (10.7 % vs. 9.6 % without monitoring) but in permanent paralysis (1.8 % vs. 3.0 %). CONCLUSIONS: It may be concluded that intraoperative electrophysiological monitoring of the RLN is a simple and accepted method with low complications reducing the incidence of permanent RLN palsy rate. We found the monitoring especially useful for operations of recurrent goiter and carcinomas of the thyroid gland as well as for learning thyroid gland surgery.