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1.
Urology ; 137: 131-132, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32115063
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 220-224, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192298

RESUMEN

As an emerging treatment method, watch and wait (W&W) strategy is not the standard treatment for rectal cancer patients but recommended by some guidelines. The legal risk of W&W is that once the medical behavior fails to achieve the desired effect, the patient may think that it is because of the wrong choice of treatment plan and delay of radical resection, thus causing medical dispute. As for the above legal risks, medical personnel should fulfill higher obligations when carrying out W&W strategy after neoadjuvant treatment for rectal cancer, including confirming that the treatment method has relatively reliable evidence-based medical evidence, fully implementing the information obligation and obtaining informed consent of the patient, and formulating standardized treatment procedures to ensure the standardization of medical behavior. At the same time, through patient education and communication, patients are aware of and coordinate with the efforts made by medical staff to improve patients' outcomes and quality of life, so as to understand the possible benefits and risks of this treatment strategy, as well as the efficacy and damage of complying with conventional treatment, and make final decision together with the medical staff.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Consenso , Humanos , Recurrencia Local de Neoplasia , Derechos del Paciente , Calidad de Vida , Neoplasias del Recto/terapia , Espera Vigilante
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 225-229, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192299

RESUMEN

The comprehensive treatment of solid tumor has become a mature treatment model. Under this model, many tumors, such as breast cancer, anal squamous cell carcinoma, rectal gastrointestinal stromal tumor and rectal cancer, are undergoing the evolutionary process of reducing the extent of surgery and witnessing an increasing demand for organ preservation. Watch and wait (W&W) after neoadjuvant chemoradiation therapy (nCRT) for rectal cancer is a hot topic in recent years. Available data suggest that patients with clinical or expected pathologic complete remission who adopt a W&W strategy are more likely to achieve an outcome similar to surgery, but with a significant improvement in quality of life. From the perspective of the evolution of surgical oncology, it is necessary to conduct further researches on patient screening, strategy improvement, evaluation optimization, and risk control during implementation. Encouraging doctor-patient shared decision-making, adequate patient communication and informed consent, careful design and practice of clinical research, and accumulation of high-level evidence are crucial to this effort. The concept of "intentional W&W" will help to promote the researches, and we should also be alert to the challenges and risks in the implementation process.


Asunto(s)
Neoplasias del Recto , Oncología Quirúrgica , Humanos , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Calidad de Vida , Neoplasias del Recto/terapia , Espera Vigilante
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 230-236, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192300

RESUMEN

In 2004, Habr-Gama reported a new group of rectal cancer patients achieving clinical complete response (cCR) after neoadjuvant chemoradiotherapy, who were able to get a satisfactory curative effect after a non-operative watch and wait (W&W) strategy. Since then, W&W has attracted more and more public attention. Although results of accumulating clinical studies have shown that W&W strategy is feasible for treating part of rectal cancer patients, there is still a lack of evidence-based medical evidence. Therefore, the feasibility and safety of the strategy still need further investigation. The main focuses are on the optimized scheme of chemoradiotherapy, the timing and standard to evaluate a cCR, and the shortage of a more precise approach to judging and predicting cCR. Whether a salvage surgery is safe and feasible for local regeneration, the risk of increasing distant metastasis and long-term oncologic and functional outcomes of patients also remain uncertain. Based on the literature and the institute's experience, this paper will elaborate the current development status and existing problems of W&W and look forward to the application prospect and future challenges.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Quimioradioterapia , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/terapia , Resultado del Tratamiento , Espera Vigilante
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 237-242, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192301

RESUMEN

Watch and wait (W&W) after neoadjuvant treatment of rectal cancer has been a focus in the field of rectal cancer in recent years. Many Chinese or international centers have accumulated valuable experience through conducting clinical research, but there are many disputes about the details of developing W&W, and there is also a problem of insufficient evidence level. Dozens of experts of gastrointestinal surgery, oncology, radiotherapy, pathology and radiology shared the experience of developing W&W and compiled the consensus on the W&W policy in rectal cancer patients after neoadjuvant treatment (2020). This article further analyzes and interprets 5 issues that are likely to cause confusion in consensus, including near-cCR and prolonged waiting time, the relationship between cCR and pCR, the role of biopsy in W&W, local resection, and contact X-ray brachytherapy, and at the same time explains the adjustments in the consensus based on national conditions.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Quimioradioterapia , Consenso , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/terapia , Resultado del Tratamiento , Espera Vigilante
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 243-247, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192302

RESUMEN

After neoadjuvant chemoradiotherapy(nCRT), 15%-40% of rectal cnacers has a pathological complete response (pCR), with non-malignant cells demonstrated in histological assessment of the surgical resection specimen. Since these patients have excellent oncological outcomes, there has been a rapidly growing interest in organ preservation for those who achieve a clinical complete response (cCR), that is "Watch and Wait strategy" (W&W). One of the major challenges in the W&W of rectal cancer is the careful and precise selection of patients suitable for this approach. The published series on W&W has all used different modalities to assess response post nCRT, including the MSKCC's three-tiered evaluation plan and Mercury's mrTRG criteria. Except significant heterogeneous results, the evidence available comes mostly from retrospective cohort studies, furthermore, there is a lack of data of long-term outcomes. How to accurately screen pCR patients preoperatively is an important and difficult issue of clinical concern.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Quimioradioterapia , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Espera Vigilante
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 248-251, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192303

RESUMEN

Some studies have demonstrated promising results of watch and wait (W&W) approaches in carefully selected patients with locally advanced rectal cancer who get a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This approach of organ- preservation helps patients avoid surgery and its related morbidity and mortality. nCRT will lead to the regression of the tumor cells and the uneven distribution of the residual tumor cells. The reliability of biopsy is still unsatisfactory in W&W strategy due to the high ratio of false negative cases. Therefore, the patients with negative histopathological assessment should also receive a strict follow-up. In the future, immune microenvironment and molecular markers, patient derived organoid, circulating tumor cells (CTCs) and circulating cell-free nucleic acids (cfDNA) may be helpful for screening and monitoring patients undergoing W&W.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Quimioradioterapia , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/terapia , Reproducibilidad de los Resultados , Resultado del Tratamiento , Microambiente Tumoral , Espera Vigilante
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 252-257, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192304

RESUMEN

For locally advanced (T3-4/N+M0) rectal cancer (LARC), radiation-based neoadjuvant therapy followed by total mesorectal excision (TME) is the standard treatment. For those who achieved clinical complete response (cCR), a non-operative management called "watch and wait" (W&W) strategery can preserve organ function and improve the life quality. For W&W strategy, radiotherapy is still the core part of neoadjuvant therapy. To increase the tumor response grade and cCR rate is the goal of optimized neoadjuvant regimens. In this review, we summarized the role of radiotherapy in the W&W strategy and discussed the advances of optimized radiation-based neoadjuvant therapy to achieve higher cCR rate, including new radiosensitizing agents, induction and consolidation chemotherapy, combination with immunotherapy, and prolonged interval time. All of the above efforts aim to improve patient survival and quality of life.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Humanos , Recurrencia Local de Neoplasia , Calidad de Vida , Neoplasias del Recto/terapia , Resultado del Tratamiento , Espera Vigilante
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 258-265, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192305

RESUMEN

Objective: To explore the safety and efficacy of watch and wait strategy and organ preservation surgery after total neoadjuvant treatment for MRI stratified low-risk rectal cancer. Methods: A prospective single arm phase Ⅱ trial developed at Department of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute was preliminarily analyzed. Subjects were enrolled from August 2016 to January 2019. Low-risk rectal cancer with following MRI features were recruited: mid-low tumor, mrT2-3b, MRF (-), EMVI (-), CRM (-), differentiation grade 1-3. Patients received intensity-modulated radiotherapy (IMRT) 50.6 Gy/22f with concurrent capecitabine and 4 cycles of consolidation CAPEOX. Patients with cCR/near-cCR confirmed by physical examination, rectal MRI, endoscopy, and serum CEA were recommended for watch & wait approach or local excision (LE). The main study outcomes were 2-year organ preservation rate (OPR) and sphincter preservation rate (SPR). Results: Thirty-eight patients were eligible for analysis, including 24 males and 14 females with median age of 56 years; 9 cases of mrT2 (23.7%), 14 cases of mrT3a (36.8%) and 15 cases of mrT3b (39.5%); 5 cases of well differentiated adenocarcinoma (13.2%), 32 cases of moderately differentiated adenocarcinoma (84.2%) and 1 case of mucinous adenocarcinoma (2.6%). Carcinoemobryonic antigen (CEA) was elevated before treatment in 1 case. One case (2.6%) of grade 3 radiation dermatitis occurred during IMRT; 18 cases (47.4%) occurred grade 3 to 4 adverse events during consolidation chemotherapy. After total neoadjuvant treatment, the cCR and near-cCR rates were 42.1% (16/38) and 23.7% (9/38), respectively, while non-cCR rate was 34.2% (13/38). Twenty patients (20/38, 52.6%) of cCR or near-cCR underwent watch & wait approach, with a local regrowth rate of 20% (4/20). Four patients received LE, including one salvage LE. Thirteen patients (4 were ypCR) received radical resection, including 10 cases of initial low anterior resections (LAR), 1 cases of initial abdominal perineal resection (APR) and 2 cases of salvage LAR, four patients refused operation. The median follow-up time was 23.5 (8.5-38.3) months. At the last interview of follow-up, the OPR and SPR were 52.6% (20/38) and 84.2% (32/38), respectively. Only one patient developed lung metastasis and no local recurrence occurred after radical resection or LE. Conclusion: Total neoadjuvant treatment for low-risk rectal cancer achieves high cCR/near-cCR rate, with increased probability of receiving watch and wait approach and organ preservation in this subgroup.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Preservación de Órganos , Estudios Prospectivos , Neoplasias del Recto/terapia , Resultado del Tratamiento , Espera Vigilante
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 281-288, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192308

RESUMEN

Objective: To investigate the feasibility and safety of sphincter-preserving surgery after neoadjuvant chemoradiotherapy (nCRT) with consolidation chemotherapy in the interval period or total neoadjuvant therapy (TNT) for low rectal cancer. Methods: A descriptive case series study was carried out. Clinical data of patients with locally advanced low rectal cancer (LALRC) who achieved complete clinical response (cCR) or nearly cCR (near-cCR) after nCRT at the Department of Colorectal Surgery of Fujian Medical University Union Hospital from May 2015 to February 2019 were retrospectively analyzed. Case inclusion criteria: (1) Low rectal adenocarcinoma within 6 cm from the anal verge. (2) After nCRT, tumor presented markedly regression as mucosal nodule or abnormalities, superficial ulcer, scar or a mucosal erythema (< 2 cm); no regional lymph node metastasis or distant metastasis was found in rectal ultrasonography, pelvic MRI and PET-CT; MRI showed obvious fibrosis in the original tumor site; and post-treatment CEA was normal. (3) The patient and the family members adhered to receive the transanal full-thickness local excision with informed consent. (4) When the residual lesions were difficult to detect after nCRT, patients received the watch and wait (W&W) strategy. Exclusion criteria: (1) Before nCRT, pathological results showed poorly differentiated or signet-ring cell carcinoma; lateral lymph node metastasis was suspected. (2) When the residual lesion size was more than 3 cm after nCRT, it was difficult to perform local excision. The consolidation nCRT group received 3-4 cycles of CAPOX regimen (oxaliplatin and capecitabine) or six cycles of mFOLFOX6 (oxaliplatin, leucovorin, and 5-fluorouracil) combined with the long-course radiotherapy (intensity-modulated radiation therapy with a total dose of 50.4Gy). Patients with concurrent chemotherapy more than or equal to five cycles of CAPOX or eight cycles of mFOLFOX6 were defined as total neoadjuvant therapy (TNT) group. Local resection was recommended for patients who were near-cCR according to modified MSKCC criteria 8-33 weeks after the end of radiotherapy. Patients with a near-cCR, who were judged as ycN0 according to PET-CT and MRI and were ypT0 after local excision, could enter the W&W strategy. Patients with pathologic stage more advanced than ypT1, and those with positive resection margin, or lymphovascular invasion were recommended for salvage radical surgery after local excision. The ypT1 patients with a negative resection margin and without lymphovascular invasion might receive the W&W management carefully if they refused radicalsurgery to sacrifice the sphincter for low rectal cancer. Results: Of 32 patients, 14 were males and 18 were females with the average age of 59 years old. Twenty-three patients underwent consolidation nCRT, and 9 received TNT. The first evaluation after treatments showed 19 cases with cCR and 13 with near-cCR. Twenty-nine patients received local excision while 3 patients with undetectable lesions received W&W policy. Four cases (12.5%) underwent salvage radical surgery with abdominoperineal resection. After local excision, 3 cases underwent salvage radical surgery immediately, and the final pathologic result was ypT3N0, ypT2N0, and ypT2N0 respectively, of whom 2 cases were in the group of consolidation CRT and 1 was in the TNT group. Of these 3 cases, 1 case with an initial cT3 stage showed a pathologic stage of ypT1 and a negative circumferential resection margin after consolidation nCRT and local excision, however, the final pathologic stage was ypT3 with fragmented tumor deposits in the mesorectum after the salvage radical surgery. Meanwhile 1 patient in the TNT group receiving W&W suffered from intraluminal regrowth after 7.4 months follow-up and underwent salvage abdominoperineal resection. One patient in the consolidation nCRT group died of stroke 42.5 months after local resection. Another patient in the TNT group had cerebral metastasis 10 months after the W&W policy, but no local recurrence was found in the pelvic cavity, then received resection of the metastatic tumors. The average follow-up for all the patients was 23 (5-51) months. The cumulative local regrowth rate was 5.0%. The overall survival rate was 85.7%, and the sphincter-preservation rate was increased from 25.0% (28/32) in the original plan to 87.5% (28/32) actually. The 3-year disease-free survival rate was 89.7%. The 3-year organ-preserving survival rate was 85.7%, and the 3-year stoma-free survival rate was 82.5%. At present, 31 patients still survived. Conclusions: After nCRT with consolidation chemotherapy or TNT for low rectal cancer, patients with cCR, ycN0 according to PET-CT and MRI, and ypT0 after local excision, can consider the W&W strategy. Strict patient selection with a near-cCR for local resection and sphincter-preserving strategy can reduce the local regrowth of cancer, and the short-term outcomes are satisfactory.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto , Quimioradioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias del Recto/terapia , Recto , Estudios Retrospectivos , Resultado del Tratamiento , Espera Vigilante
11.
J Formos Med Assoc ; 119(3): 747-751, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32113824

RESUMEN

An outbreak of respiratory illness proved to be infected by a 2019 novel coronavirus, officially named Coronavirus Disease 2019 (COVID-19), was notified first in Wuhan, China, and has spread rapidly in China and to other parts of the world. Herein, we reported the first confirmed case of novel coronavirus pneumonia (NCP) imported from China in Taiwan. This case report revealed a natural course of NCP with self-recovery, which may be a good example in comparison with medical treatments.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Espera Vigilante , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Taiwán
13.
Internist (Berl) ; 61(1): 5-12, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31912164

RESUMEN

Cough is one of the most frequent causes for consultation in primary care. The diagnostic characteristics in primary care with a broad spectrum of causes and unspecific symptoms are presented using the example of acute and chronic cough. The understanding of the formation of the cough stimulus and the induction by inflammatory, mechanical and chemical triggers as well as the significance of the stimulus threshold of the cough receptor facilitate the comprehension of the various possible causes of cough. The necessary diagnostic procedures are based on the exclusion of warning symptoms that necessitate emergency inpatient treatment, on the duration of symptoms and the spectrum of causes to be expected from them. Ambiguities often remain even with careful basic diagnostics. Watchful waiting and active surveillance can initially be the most sensible approach but should not be misconstrued as carelessness. It necessitates follow-up controls and increased attention especially in patients with a high-risk constellation (e.g. multimorbidity, immune suppression, heart failure) in order to be able to quickly react to the development of treatable aspects or even dangerous courses of disease.


Asunto(s)
Tos/diagnóstico , Servicio de Urgencia en Hospital , Atención Primaria de Salud , Enfermedad Aguda , Enfermedad Crónica , Humanos , Derivación y Consulta , Espera Vigilante
14.
N Engl J Med ; 382(5): 405-415, 2020 01 30.
Artículo en Inglés | MEDLINE | ID: mdl-31995686

RESUMEN

BACKGROUND: Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is unknown. METHODS: In this open-label, multicenter, noninferiority trial, we recruited patients 14 to 50 years of age with a first-known, unilateral, moderate-to-large primary spontaneous pneumothorax. Patients were randomly assigned to immediate interventional management of the pneumothorax (intervention group) or a conservative observational approach (conservative-management group) and were followed for 12 months. The primary outcome was lung reexpansion within 8 weeks. RESULTS: A total of 316 patients underwent randomization (154 patients to the intervention group and 162 to the conservative-management group). In the conservative-management group, 25 patients (15.4%) underwent interventions to manage the pneumothorax, for reasons prespecified in the protocol, and 137 (84.6%) did not undergo interventions. In a complete-case analysis in which data were not available for 23 patients in the intervention group and 37 in the conservative-management group, reexpansion within 8 weeks occurred in 129 of 131 patients (98.5%) with interventional management and in 118 of 125 (94.4%) with conservative management (risk difference, -4.1 percentage points; 95% confidence interval [CI], -8.6 to 0.5; P = 0.02 for noninferiority); the lower boundary of the 95% confidence interval was within the prespecified noninferiority margin of -9 percentage points. In a sensitivity analysis in which all missing data after 56 days were imputed as treatment failure (with reexpansion in 129 of 138 patients [93.5%] in the intervention group and in 118 of 143 [82.5%] in the conservative-management group), the risk difference of -11.0 percentage points (95% CI, -18.4 to -3.5) was outside the prespecified noninferiority margin. Conservative management resulted in a lower risk of serious adverse events or pneumothorax recurrence than interventional management. CONCLUSIONS: Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary spontaneous pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events. (Funded by the Emergency Medicine Foundation and others; PSP Australian New Zealand Clinical Trials Registry number, ACTRN12611000184976.).


Asunto(s)
Tratamiento Conservador , Drenaje , Neumotórax/terapia , Adolescente , Adulto , Tubos Torácicos , Drenaje/métodos , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Neumotórax/diagnóstico por imagen , Complicaciones Posoperatorias , Radiografía Torácica , Recurrencia , Resultado del Tratamiento , Espera Vigilante , Adulto Joven
15.
16.
BMJ ; 368: l6779, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31941696

RESUMEN

The studyChappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia.


Asunto(s)
Preeclampsia , Nacimiento Prematuro , Femenino , Humanos , Recién Nacido , Madres , Embarazo , Evaluación de la Tecnología Biomédica , Espera Vigilante
17.
Urology ; 137: 138-145, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31899227

RESUMEN

OBJECTIVE: To evaluate treatment preferences of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) before and after using a web-based decision aid (DA). PATIENTS AND METHODS: Between July 2016 and January 2017 patients were invited to use a web-based LUTS/BPH DA. Treatment preferences (for lifestyle advices, medication or surgery) before and after DA use and responses on values clarification exercises were extracted from the DA. RESULTS: In total, 126 patients were included in the analysis. Thirty-four percent (43/126) had not received any previous treatment and were eligible for (continuation of) lifestyle advices or to start medication, as initial treatment. The other 66% (83/126) did use medication and were eligible, either for continuing medication or to undergo surgery. Before being exposed to the DA, 67 patients (53%) were undecided and 59 patients (47%) indicated an initial treatment preference. Half of the patients who were initially undecided were able to indicate a preference after DA use (34/67, 51%). Of those with an initial preference, 80% (47/59) confirmed their initial preference after DA use. Five out of 7 values clarification exercises used in the DA were discriminative between final treatment preferences. In 79%, the treatment preferred after DA use matched the received treatment. Overall, healthcare providers were positive about DA feasibility. CONCLUSION: Our findings suggest that a LUTS/BPH DA may help patients to confirm their initial treatment preference and support them in forming a treatment preference if they did not have an initial preference.


Asunto(s)
Toma de Decisiones , Técnicas de Apoyo para la Decisión , Síntomas del Sistema Urinario Inferior , Prioridad del Paciente/estadística & datos numéricos , Hiperplasia Prostática , Calidad de Vida , Anciano , Tratamiento Conservador/métodos , Tratamiento Conservador/psicología , Humanos , Estilo de Vida , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/psicología , Síntomas del Sistema Urinario Inferior/terapia , Masculino , Persona de Mediana Edad , Países Bajos , Hiperplasia Prostática/patología , Hiperplasia Prostática/fisiopatología , Hiperplasia Prostática/psicología , Hiperplasia Prostática/terapia , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/psicología , Encuestas y Cuestionarios , Espera Vigilante
18.
JAMA ; 323(2): 149-163, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31935027

RESUMEN

Importance: Understanding adverse effects of contemporary treatment approaches for men with favorable-risk and unfavorable-risk localized prostate cancer could inform treatment selection. Objective: To compare functional outcomes associated with prostate cancer treatments over 5 years after treatment. Design, Setting, and Participants: Prospective, population-based cohort study of 1386 men with favorable-risk (clinical stage cT1 to cT2bN0M0, prostate-specific antigen [PSA] ≤20 ng/mL, and Grade Group 1-2) prostate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20-50 ng/mL, or Grade Group 3-5) prostate cancer diagnosed in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, with surveys through September 2017. Exposures: Treatment with active surveillance (n = 363), nerve-sparing prostatectomy (n = 675), external beam radiation therapy (EBRT; n = 261), or low-dose-rate brachytherapy (n = 87) for men with favorable-risk disease and treatment with prostatectomy (n = 402) or EBRT with androgen deprivation therapy (n = 217) for men with unfavorable-risk disease. Main Outcomes and Measures: Patient-reported function, based on the 26-item Expanded Prostate Index Composite (range, 0-100), 5 years after treatment. Regression models were adjusted for baseline function and patient and tumor characteristics. Minimum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symptoms, and 4 to 6 for bowel and hormonal function. Results: A total of 2005 men met inclusion criteria and completed the baseline and at least 1 postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1529 of 1993 participants [77%] were non-Hispanic white). For men with favorable-risk prostate cancer, nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years (adjusted mean difference, -10.9 [95% CI, -14.2 to -7.6]) and sexual function at 3 years (adjusted mean difference, -15.2 [95% CI, -18.8 to -11.5]) compared with active surveillance. Low-dose-rate brachytherapy was associated with worse urinary irritative (adjusted mean difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean difference, -5.0 [95% CI, -7.6 to -2.4]) function at 1 year compared with active surveillance. EBRT was associated with urinary, sexual, and bowel function changes not clinically different from active surveillance at any time point through 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at 1 year (adjusted mean difference, -4.1 [95% CI, -6.3 to -1.9]), but better sexual function at 5 years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through 5 years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than prostatectomy. Conclusions and Relevance: In this cohort of men with localized prostate cancer, most functional differences associated with contemporary management options attenuated by 5 years. However, men undergoing prostatectomy reported clinically meaningful worse incontinence through 5 years compared with all other options, and men undergoing prostatectomy for unfavorable-risk disease reported worse sexual function at 5 years compared with men who underwent EBRT with ADT.


Asunto(s)
Antagonistas de Andrógenos/efectos adversos , Braquiterapia/efectos adversos , Medición de Resultados Informados por el Paciente , Prostatectomía/efectos adversos , Neoplasias de la Próstata/terapia , Radioterapia/efectos adversos , Anciano , Antagonistas de Andrógenos/uso terapéutico , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Radioterapia/métodos , Disfunciones Sexuales Fisiológicas/etiología , Resultado del Tratamiento , Incontinencia Urinaria/etiología , Espera Vigilante
19.
Cancer Treat Rev ; 84: 101964, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32000055

RESUMEN

Various methods categorize tumour response after neoadjuvant therapy, including down-staging and tumour regression grading. Response categories allow comparison of different treatments within clinical trials and predict outcome. A reproducible response categorization could identify subgroups with high or low risk for the most appropriate subsequent treatments, like watch and wait. Lack of standardization and interpretation difficulties currently limit the usability of these approaches. In this review we describe these difficulties for the evaluation of chemoradiation in rectal cancer. An alternative approach of tumour response is based on patterns of residual disease, including fragmentation. We summarise the evidence behind this alternative method of response categorisation, which explains a number of very relevant clinical discrepancies. These issues include differences between downstaging and tumour regression, high local regrowth in advanced tumours during watchful waiting procedures, the importance of resection margins, the limited value of post-treatment biopsies and the relatively poor outcome of patients with a near complete pathological response. Recognition of these patterns of response can allow meaningful development of novel biomarkers in the future.


Asunto(s)
Terapia Neoadyuvante , Neoplasia Residual/diagnóstico , Neoplasias del Recto/terapia , Espera Vigilante/métodos , Humanos , Estadificación de Neoplasias , Neoplasia Residual/epidemiología , Resultado del Tratamiento
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 1-9, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-31958923

RESUMEN

Patients with clinical complete response(cCR) after neoadjuvant treatment receiving the Watch and Wait('W&W') policy can achieve similar survival of those with yeild pathological complete response (ypCR), and have significantly improved quality of life compared to those undergoing radical operation. Based on thoroughly reviewing the literatures and guidelines at home and abroad, and referring associated clinical experiences from a lot of domestic medical centers, the present version of Chinese Consensus on W&W was established by a panel of many experts of gastrointestinal surgery, medical oncology, radiation oncology, pathology, endoscopy, radiology. This consensus mainly elucidates important conceptions of the W&W policy, current key evidences, risks and benefits for patients, conditions to carry out W&W, criteria of cCR diagnosis, timing of evaluation, follow - up plan, salvage treatment for local relapse and distant metastasis, associated problems of local resection, and is expected to facilitate the clinical practice and research of W&W policy in China.


Asunto(s)
Terapia Neoadyuvante , Neoplasias del Recto/terapia , Espera Vigilante , China , Consenso , Humanos , Guías de Práctica Clínica como Asunto , Calidad de Vida , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Inducción de Remisión/métodos , Resultado del Tratamiento
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