RESUMO
PURPOSE: The combination of taxanes and anthracyclines has proven efficacy in node-positive (N+) premenopausal primary breast cancer patients. Ovarian ablation is also associated with better survival outcomes in premenopausal hormone-receptor positive (HR+) patients. Therefore, this trial aims to determine the superiority of combined hormonal treatment of ovarian ablation with tamoxifen (TMX) versus TMX alone, in premenopausal N+, HR + patients receiving adjuvant chemotherapy (AC) with taxane and anthracycline. MATERIALS AND METHODS: Premenopausal women who had surgically removed breast cancer with histologically confirmed N + and HR+ were included in the trial. The AC consisted of six cycles of taxotere, adriamycin, cytoxan or taxotere, epirubicin and cytoxan with the completion of radiation therapy. Patients were randomly assigned to receive TMX 20 mg/day for 5 years or up to menopause or TMX 20 mg/day for 5 years plus goserelin (GOS) 3.6 mg injection per month for 2 years. The primary end point was disease-free survival (DFS). RESULTS: Between 2003 and 2011, 101 consecutive patients were allocated to TMX (51 patients) and TMX/GOS (50 patients) groups. The mean follow-up period was 52.4 ± 2.8 months. DFS was 43.0 ± 3.6 months versus 49.9 ± 4.22 months (P = 0.13) and overall survival was 51.1 ± 3.8 months versus 53.1 ± 4.2 months (P = 0.50) in the TMX and TMX/GOS groups, respectively. The results showed 9% absolute risk reduction with respect to DFS in favor of the TMX/GOS group. CONCLUSION: This study group was comprised of stage II and III disease patients with high nodal status. The TMX/GOS combination reduced absolute risk of developing first locoregional or distant relapse by almost 9%. Longer follow-up is required to justify this protocol for routine use.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Gosserrelina/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Tamoxifeno/administração & dosagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Quimioterapia Adjuvante , Ciclofosfamida/administração & dosagem , Intervalo Livre de Doença , Docetaxel , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Pré-Menopausa , Estudos Prospectivos , Taxa de Sobrevida , Taxoides/administração & dosagem , Resultado do TratamentoAssuntos
Carcinoma Neuroendócrino/etiologia , Icterícia/etiologia , Neurofibromatose 1/complicações , Neoplasias Pancreáticas/etiologia , Idoso , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Icterícia/patologia , Icterícia/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgiaRESUMO
Testicular tumors are the most common solid tumors in young adult males. Patients with testicular tumor often present with painless scrotal mass. Rarely, symptoms are related to metastases. We describe the case of a patient presenting with abdominal pain due to retroperitoneal lymphadenopathy. We describe the magnetic resonance imaging findings of lumbar spine osseous metastasis.
Assuntos
Dor Abdominal/etiologia , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Retroperitoneais/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias Testiculares/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Vértebras Lombares/patologia , Doenças Linfáticas/diagnóstico , Masculino , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Orquiectomia , Radiografia Abdominal/métodos , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Testículo/diagnóstico por imagem , Testículo/patologia , Testículo/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: There is an emerging consensus on conversion from calcineurin inhibitor (CNI)-based regimens to proliferation signal inhibitor (PSI)-based protocols for the prevention of a progressive decline in graft function due to CNI toxicity. METHODS: Thirty-one primary renal transplant recipients within 17-48 years of age (mean, 32.2 +/- 1.6) were enrolled in this dual-center study. Eligible patients had a baseline (pre-engraftment) biopsy and completed at least 12 months of follow-up with deteriorating graft function indicative of chronic CNI toxicity with or without nonspecific interstitial fibrosis/tubular atrophy (IF/TA) on a biopsy specimen. A fast conversion protocol, being defined as a 50% initial reduction followed by complete withdrawal of CNI drug within 2 weeks of introducing rapamycin was performed in all patients. A sirolimus (SRL) loading dose was not prescribed; all subjects directly received maintenance (2-5 mg/d) doses of the drug. The primary endpoint of this study was assessement of renal function using cGFR and renal histology by protocol biopsy at 1 year after conversion. RESULTS: The mean follow-up after conversion was 21.6 months. The difference between cGFR before compared with cGFR after 12 months after conversion (40.8 +/- 2.36 mL/min vs 55.7 +/- 3.6 mL/min; P < .000) and at the last follow-up (40.8 +/- 2.36 mL/min vs 53.8 +/- 2.96 mL/min; P < .000) was significant. The mean IF/TA with glomerulosclerosis and chronic vasculopathy scores of biopsy specimens at baseline, during conversion, and at 12 months of the study were 2.25 +/- 0.3, 3.30 +/- 0.24, and 3.0 +/- 0.30, respectively. The change in scores was indicative of mild progression; however, the difference was not significant. IF/TA, glomerulosclerosis, and chronic vasculopathy scores improved in 8 (30%) subjects, remained unchanged in 11 (42%) and worsened in 7 (28%) after 1 year of SRL therapy. After conversion there was no patient or graft loss in this group. Moreover, SCr and GFR improved in 21 or 29 patients (72%), remained stable in 4 (14%), and decreased in 4 (14%) patients. The predictors of successful conversion in our study were GFR > or = 40.6 mL/min, SCr < or = 2.34 mg/dL, and histological allograft damage score < or =3. CONCLUSION: SRL-MPA/MMF-ST combination may be a good therapeutic strategy against chronic CNI toxicity, particularly for patients whose conversion biopsy specimens demonstrated mild IF/TA, glomerulosclerosis, and chronic vasculopathy scores (< or =3.1 +/- 0.3).
Assuntos
Calcineurina/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Rim/imunologia , Sirolimo/uso terapêutico , Adolescente , Adulto , Biópsia , Pressão Sanguínea , Ciclosporina/sangue , Ciclosporina/uso terapêutico , Seguimentos , Taxa de Filtração Glomerular , Teste de Histocompatibilidade , Humanos , Imunossupressores/sangue , Imunossupressores/uso terapêutico , Transplante de Rim/patologia , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , Sirolimo/sangue , Doadores de Tecidos/estatística & dados numéricos , Adulto JovemRESUMO
Retrorectal cyst-hamartoma is a relatively rare disease. Total excision of the cyst is indicated to prevent infection and malign proliferation. We present a case of retrorectal cyst-hamartoma in a 55-year-old woman that was successfully treated by complete surgical excision.
Assuntos
Cistos/cirurgia , Hamartoma/cirurgia , Doenças Retais/cirurgia , Cistos/diagnóstico , Cistos/patologia , Feminino , Hamartoma/diagnóstico , Hamartoma/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Doenças Retais/patologiaRESUMO
In this study prognostic significance and clinical value of mutant p53 gene in bladder transitional cell tumors is investigated. In our clinic, between 1997-2000, transurethral resection was performed in 48 cases, 3 females (6%) and 45 males (94%) with the diagnosis of primary bladder tumor, age ranges between 30-81 years old (average 58.9 +/- 9.9). The patients whose pathology results were transitional cell carcinoma were gathered into two groups as p53 positive and p53 negative by immunohistochemical study. These cases who were followed 1-36 months were compared to each other for pathologic state, tumor grade, recurrence and survival. It's found out that mutant p53 accumulation is related to high grade and pathologic stage tumors. But it's concluded that p53 positivity doesn't effect recurrence and survival rates.
Assuntos
Carcinoma de Células de Transição/genética , Genes p53 , Neoplasias da Bexiga Urinária/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Feminino , Genes p53/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia , Prognóstico , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologiaRESUMO
Prostate specific antigen (PSA) is the most important tumour marker which, used routinely, proved to have a positive correlation with tumour volume and pathological stage. To evaluate the relationship between serum PSA and histologic grading of prostatic carcinoma, preoperative PSA determinations were made in 25 patients with prostatic cancer. Biopsy materials were evaluated and the Gleason scores were adjusted for histologic grading. The higher values of PSA were proportional to the Gleason scores of the primary prostatic biopsy.