RESUMEN
PURPOSE: Adjuvant chemotherapy for gastric cancer, particularly stage III, improves survival after curative D2 gastrectomy. We investigated the clinical value of the lymph-node ratio (LNR; number of metastatic lymph nodes/number of lymph nodes examined) for selecting the appropriate adjuvant chemotherapy regimen in patients with D2-resected stage II/III gastric cancer. METHODS: We reviewed the data of 819 patients who underwent curative D2 gastrectomy followed by adjuvant chemotherapy. Of them, 353 patients received platinum-based chemotherapy and 466 received TS-1. The patients were categorized into three groups according to their LNR (LNR 1, 0-0.1; LNR 2, > 0.1-0.25; and LNR 3, > 0.25), and their disease-free survival (DFS) was evaluated. RESULTS: The DFS curves of the patients were well separated according to stage and LNR. In multivariate analyses, an LNR > 0.1 was strongly associated with the 3-year DFS (hazard ratio 2.402, 95% confidence interval 1.607-3.590, P < 0.001). Platinum-based chemotherapy improved the 3-year DFS compared to TS-1 in patients with LNR 3 group in stage III gastric cancer (platinum vs. TS-1, median DFS 26.87 vs. 16.27 months, P = 0.028). An LNR > 0.1 was associated with benefiting from platinum-based adjuvant chemotherapy in stage III gastric cancer patients with lymphovascular invasion (platinum vs. TS-1, median DFS 47.57 vs. 21.77 months, P = 0.011). CONCLUSIONS: The LNR can be used to select the appropriate adjuvant chemotherapy regimen for patients with D2-resected gastric cancer, particularly in stage III.
Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Conducta de Elección , Desoxicitidina/análogos & derivados , Fluorouracilo/análogos & derivados , Gastrectomía , Ganglios Linfáticos/patología , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Capecitabina , Quimioterapia Adyuvante/clasificación , Cisplatino/uso terapéutico , Terapia Combinada , Desoxicitidina/uso terapéutico , Femenino , Fluorouracilo/uso terapéutico , Gastrectomía/métodos , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Oxaloacetatos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Análisis de Supervivencia , Tegafur/uso terapéutico , Uracilo/uso terapéuticoRESUMEN
El manejo de los pacientes con cáncer de mama temprano o localmente avanzado requiere de la evaluación inicial de un grupo de médicos familiarizados con el diagnóstico, estadificación y tratamientos de estas enfermedades, de tal manera que se pueda optimizar los resultados no solamente oncológicos (Curación), sino también cosméticos. La decisión sobre el tratamiento local (cirugía y Radioterapia) y sistémico (Quimioterapia y Hormonoterapia) está basada en las características clínicas y moleculares de tumor, así como por las preferencias del paciente
The management of patients with earlyor locally advanced breast cancer requires the initial evaluation of a group of physicians familiar with the diagnosis, staging and treatment of these diseases, in order to optimize the results not only oncological (Healing), but also cosmetics. The decision on local treatment (surgery and Radiotherapy) and systemic treatment (Chemotherapy and Hormonotherapy) is based on the clinical and molecular characteristics of the tumor, aswell as on the patient's preferences
Asunto(s)
Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/radioterapia , Quimioterapia Adyuvante/clasificación , Axila/cirugía , Neoplasias de la Mama/tratamiento farmacológico , Mastectomía Segmentaria , Oncología MédicaRESUMEN
Purpose. Second-line chemotherapy has been shown to benefit patients with advanced gastric cancer (AGC), extending the overall survival (OS) and progression-free survival (PFS). This study aimed to assess the efficacy and cost-effectiveness of second-line treatment for elderly patients with AGC. Methods. Medical records and follow-up information of elderly patients (≥70 years) with AGC who received second-line chemotherapy were collected. A Markov model comprising three health states PFS, progressive disease and death was developed to simulate the process of AGC. Cost was calculated from the perspective of Chinese society. Sensitivity analyses were applied to explore the impact of essential variables. Results. Forty-three elderly patients with AGC receiving second-line chemotherapy were included in our study. The median OS was 6.0 months (95% confidence interval (CI) 3.90-8.10) and PFS was 3.1 months (95% CI 1.38-4.82). No treatment-related death occurred. The most frequently drug-related grade 3/4 AEs were diarrhea (2.3%), leukopenia (16.3%) and nausea (7.0%). The incremental cost-effective ratio was $18,223.75/QALY for second-line chemotherapy versus BSC, which was below the threshold of 3× the per capita GDP of China, $23,970.00. Conclusion. Second-line chemotherapy was an optimal strategy for elderly AGC patients in China from the efficacy and cost-effectiveness perspective (AU)
No disponible
Asunto(s)
Humanos , Anciano , Anciano de 80 o más Años , Neoplasias Gástricas/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/economía , Asistencia a los Ancianos/tendencias , Quimioterapia Adyuvante/clasificación , Quimioterapia Adyuvante , Resultado del Tratamiento , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/tendencias , 50303 , Estudios RetrospectivosRESUMEN
Las determinaciones inmunohistoquímicas y moleculares en las muestras tisulares son métodos utilizados para establecer factores pronósticos y predictivos en el cáncer de mama. Para que estas técnicas sean lo más eficaces posible se requiere de un correcto manejo de los especímenes, lo que incluye controles preanalíticos como el del tiempo de isquemia, una correcta fijación, tallado e inclusión en parafina, así como la adecuada selección de la representación del tumor que se someterá a estudio. La precisión en todos estos pasos repercutirá en un resultado óptimo de la técnica inmunohistoquímica o molecular aplicada (AU)
Molecular and immunohistochemical analysis of tissue samples are useful tools to establish prognostic and predictive factors in breast cancer. The efficiency of these techniques is based on a correct management of surgical specimens which includes pre-analytic controls such time of ischemia, appropriate fixation, gross manipulation and paraffin embedding. It is also important the right selection of tumor representation for study submission. The accuracy of all these steps will affect in the optimal result of the immunohistochemical and molecular test applied (AU)
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/metabolismo , Patología Molecular/clasificación , Patología Molecular/métodos , Biomarcadores/metabolismo , Velocidad del Flujo Sanguíneo/genética , Formaldehído/administración & dosificación , Adhesión en Parafina/métodos , Quimioterapia Adyuvante/clasificación , Quimioterapia Adyuvante/métodos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Patología Molecular , Patología Molecular/normas , Biomarcadores/análisis , Velocidad del Flujo Sanguíneo/fisiología , Formaldehído/efectos adversos , Adhesión en Parafina/normas , Quimioterapia Adyuvante/normas , Quimioterapia AdyuvanteRESUMEN
Background. To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity. Methods. Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment. Results. Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity. Conclusion. VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT (AU)
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias del Cuello Uterino/metabolismo , Neoplasias del Cuello Uterino/patología , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/normas , Dosificación/prevención & control , Radioterapia Adyuvante/métodos , Radioterapia Adyuvante/psicología , Ganglios Linfáticos/metabolismo , Control de la Radiación/métodos , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/terapia , Quimioterapia Adyuvante/clasificación , Quimioterapia Adyuvante/enfermería , Dosificación/clasificación , Radioterapia Adyuvante/clasificación , Radioterapia Adyuvante/normas , Ganglios Linfáticos/anomalías , Control de la Radiación/análisisAsunto(s)
Carcinoma/tratamiento farmacológico , Cistectomía , Quimioterapia de Inducción/clasificación , Terapia Neoadyuvante/clasificación , Terminología como Asunto , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Urotelio/efectos de los fármacos , Carcinoma/secundario , Carcinoma/cirugía , Quimioterapia Adyuvante/clasificación , Humanos , Pronóstico , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , Urotelio/patología , Urotelio/cirugíaRESUMEN
Non-Hodgkin's lymphoma (NHL) consists of a group of neoplasias involving mainly B cells and represents 90% of all lymphomas. The current available therapy is based on chemotherapy associated with the monoclonal antibody rituximab (Mab Thera(r)), which targets the CD20 protein, present in over 80% of NHL mature B cells. Recent clinical reports show a preference for combining the benefits of immunotherapy and adjuvant chemotherapy, thus generating safe and effective alternative treatments. The current review aimed at evaluating various aspects related to the use of rituximab for NHL, highlighting the possible inhibitory mechanisms of cell proliferation, the achieved clinical results, and the expected clinical and economic outcomes of treatments. The results from clinical tests indicate the need for a better understanding of the critical mechanisms of action of this antibody, which may maximize its therapeutic efficacy. This therapy not only represents a viable option to treat most types of NHLs, especially when associated with conventional chemotherapy, but also offers cost-utility and cost-effectiveness advantages.
O Linfoma não-Hodgkin (LNH) consiste em um grupo de neoplasias envolvendo, principalmente, as células B e representa 90% de todos os linfomas. A terapia atual disponível é baseada em quimioterapia associada ao anticorpo monoclonal rituximabe (Mab Thera(r)), que tem como alvo a proteína CD20, presente em mais de 80% das células B maduras do LNH. Recentes relatórios clínicos mostram preferência para combinar os benefícios da quimioterapia adjuvante e imunoterapia, gerando alternativas de tratamentos seguro e eficaz. O trabalho de revisão teve por objetivo avaliar vários aspectos relacionados à aplicação do rituximabe no LNH, destacando os possíveis mecanismos inibitórios da proliferação celular, os resultados clínicos obtidos e as implicações clínicas e econômicas esperadas para o tratamento. Os resultados de testes clínicos indicam a necessidade de uma melhor compreensão dos mecanismos críticos de ação deste anticorpo, que poderão maximizar a sua eficácia terapêutica. Essa terapia não representa apenas uma opção viável para o tratamento da maioria dos tipos de LNH, principalmente quando associado à quimioterapia convencional, mas, também, oferece vantagens em termos de custo-utilidade e custo-efetividade.
Asunto(s)
Enfermedad de Hodgkin/clasificación , Rituximab/efectos de los fármacos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Quimioterapia Adyuvante/clasificaciónRESUMEN
The reality of intraoperative radiation therapy (IORT) practice is consistent with an efficient and highly precise radiation therapy technique to safely boost areas at risk for local recurrence. Long-term clinical experience has shown that IORT-containing multi-modality regimens appear to improve local disease control, if not survival in many diseases. Research with IORT is a multidisciplinary scenario that covers knowledge from radiation beam adapted development to advance molecular biology for bio-predictability of outcome. The technical parameters employed in IORT procedures are important information to be recorded for quality assurance and clinical results analysis. In addition, specific treatment planning systems for IORT procedures are available, to help in the treatment decision-making process. A systematic revision of opportunities for research and innovation in IORT is reported including radiation beam modulation, delivery, dosimetry and planning; infrastructure and treatment factors; experimental and clinical radiobiology; clinical trials, innovation and translational research development (AU)
Asunto(s)
Humanos , Masculino , Femenino , Quimioterapia Adyuvante/clasificación , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante , Apoyo a la Investigación como Asunto/métodos , Supervivencia/psicologíaRESUMEN
Adjuvant analgesics (co-analgesics) are medications whose primary indication is the management of a medical condition with secondary effects of analgesia. Cancer pain is multifactorial and often involves inflammatory, nociceptive, and neuropathic pain subtypes. Adjuvant analgesics used in conjunction with opioids have been found to be beneficial in the management of many cancer pain syndromes; however, they are currently underutilized. Antidepressants, anticonvulsants, local anesthetics, topical agents, steroids, bisphosphonates, and calcitonin are all adjuvants which have been shown to be effective in the management of cancer pain syndromes. When utilizing analgesic adjuvants in the treatment of cancer pain, providers must take into account the particular side effect profile of the medication. Ideally, adjuvant analgesics will be initiated at lower dosages and escalated as tolerated until efficacy or adverse effects are encountered.