RESUMO
Objetivo. Comparar la efectividad, supervivencia y coste de la quimioembolización transarterial con partículas liberadoras de doxorrubicina (DEB-TACE) y la quimioembolización convencional (cTACE) en pacientes con carcinoma hepatocelular (CHC) irresecable. Material y métodos. Estudio unicéntrico, observacional y retrospectivo que comparó 60 pacientes con CHC irresecable separados en dos grupos comparables de 30 pacientes tratados con DEB-TACE y otros 30 con cTACE. Se realizaron las pruebas de χ2 y t de Student, y se utilizó el método de Kaplan Meier. Resultados. La supervivencia fue menor en hombres y en pacientes con hepatitis C (p = 0,014 y p = 0,003, respectivamente). No hubo diferencias estadísticamente significativas en la supervivencia global a los 5 años (29,99 meses; IC del 95%: 21,38-38,60 y 30,67 meses; IC del 95%: 22,65-38,70; p = 0,626) y la supervivencia libre de progresión (mediana: 11,57 meses; IC del 95%: 0,97-22,18 y 12,80 meses; IC del 95%: 0,00-32,37; p = 0,618). El tiempo medio de ingreso fue de 2,6 y 5,4 días (p < 0,001) para DEB-TACE y cTACE, respectivamente. La toxicidad grado 2-4 fue superior en el grupo cTACE (54 y 31; p < 0,001). El coste del tratamiento fue de 1.581 Euros con DEB-TACE y de 514,63 Euros con cTACE. El coste total medio fue de 3.134 Euros y 3.694,35 Euros, respectivamente (p = 0,173). Conclusión. La quimioembolización en pacientes con CHC irresecable tiene una supervivencia global cercana a 30 meses a los 5 años, independientemente de la técnica empleada. Los costes globales son similares, aunque la mejor tolerancia de la DEB-TACE justifica el mayor coste del procedimiento (AU)
Objectives. To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. Material and methods. This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ2 test, Student t-test, and Kaplan Meier method. Results. Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p = 0.014 and p = 0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p = 0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p = 0.618). The median length of hospital admission were 2.6 and 5.4 days (p < 0.001) for DEB-TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p < 0.001). The cost of the treatment was 1581 Euros for DEB-TACE and 514.63 Euros for cTACE. The overall mean cost of intervention was 3134 Euros and 3694.35 Euros, respectively (p = 0.173). Conclusions. Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure (AU)
Assuntos
Feminino , Humanos , Masculino , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica , Doxorrubicina/uso terapêutico , Carcinoma Hepatocelular/economia , Carcinoma Hepatocelular , Ondansetron , Avaliação de Eficácia-Efetividade de Intervenções , Sobrevivência , Estudos Retrospectivos , Estimativa de Kaplan-Meier , CisplatinoRESUMO
OBJECTIVES: To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. MATERIAL AND METHODS: This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ(2) test, Student t-test, and Kaplan Meier method. RESULTS: Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p=0.014 and p=0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p=0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p=0.618). The median length of hospital admission were 2.6 and 5.4 days (p<0.001) for DEB(-)TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p<0.001). The cost of the treatment was 1581 for DEB(-)TACE and 514.63 for cTACE. The overall mean cost of intervention was 3134 and 3694.35 , respectively (p=0.173). CONCLUSIONS: Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure.
Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica , Doxorrubicina/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
We report a case of acalculous cholecystitis in an AIDS patient, that appeared with insidious onset, abdominal right upper quadrant pain and fever. Cholecystectomy was performed and CMV inclusions were observed in tissue sections. CMV acalculous cholecystitis is an uncommon condition associated to the acquired immunodeficiency syndrome. It should be considered, especially when abdominal pain and fever are present in marked immunosuppressed AIDS patients. Unfortunately, a limited experience in treatment, either medical or surgical, was reported. In our case, the response to surgical procedure was successful, disappearing the abdominal pain and the fever. The patient refused both ganciclovir and foscarnet therapy.