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1.
Clin Transl Gastroenterol ; 11(6): e00162, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32568477

RESUMO

INTRODUCTION: To date, we do not know the best therapeutic scheme in locally advanced rectal cancer when patients are older or have comorbidities. METHODS: In 2009, we established a prospective treatment protocol that included short-course preoperative radiotherapy (RT) with standard surgery +/- chemotherapy in frail patients, mostly older than 80 years or with comorbidities. RESULTS: We included 87 patients; the mean follow-up was 43.5 months (0.66-106.3). Disease-specific survival and disease-free survival at 36 months were 86.3% and 82.8%; at 60 months, they were 78.2% and 78%, respectively, with a local recurrence rate of 2.5%. The rate of late radiotoxicity was 9% in the form of sacral insufficiency fracture and small bowel obstruction with one death. The interval before surgery varied according to the involvement of the mesorectal fascia, but it was less than 2 weeks in 45% of cases. The rate of R0 was 95%. Surgical complications included abdominal wound dehiscence (3.5%), anastomotic leak (2.4%), and reoperations (11.5%). Downstaging was observed in 51% of the cases, regardless of the interval before surgery. DISCUSSION: Therapeutic outcomes in our group of elderly patients and/or patients with comorbidities with neoadjuvant short-course RT are such as those of the general population treated with neoadjuvant RT-chemotherapy, all with acceptable toxicity. Therefore, this treatment scheme, with short-course preoperative RT, would be the most appropriate in this group of patients.


Assuntos
Adenocarcinoma/terapia , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Radioterapia Conformacional , Neoplasias Retais/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Comorbidade , Intervalo Livre de Doença , Idoso Fragilizado , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Protectomia , Estudos Prospectivos , Planejamento da Radioterapia Assistida por Computador , Neoplasias Retais/diagnóstico , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
2.
Cancer Chemother Pharmacol ; 82(6): 935-943, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30225601

RESUMO

BACKGROUND: Neoadjuvant therapy (NAT) for pancreatic adenocarcinoma (PDAC) patients has shown promising results in non-randomized trials. This is a multi-institutional phase II trial of NAT in resectable PDAC patients. METHODS: Patients with confirmed resectable PDAC after agreement by two expert radiologists were eligible. Patients received three cycles of GEM (1000 mg/m2/week) plus daily erlotinib (ERL) (100 mg/day). After re-staging, patients without progressive disease underwent 5 weeks of therapy with GEM (300 mg/m2/week), ERL 100 mg/day and concomitant radiotherapy (45 Gy). Efficacy was assessed using tumor regression grade (TRG) and resection margin status. Using a single-arm Simon's design, considering the therapy not useful if R0 < 40% and useful if the R0 > 70% (alpha 5%, beta 10%), 24 patients needed to be recruited. This trial was registered at ClinicalTrials.gov, number NCT01389440. RESULTS: Twenty-five patients were enrolled. Adverse effects of NAT were mainly mild gastrointestinal disorders. Resectability rate was 76%, with a R0 rate of 63.1% among the resected patients. Median overall survival (OS) and disease-free survival (DFS) were 23.8 (95% CI 11.4-36.2) and 12.8 months (95% CI 8.6-17.1), respectively. R0 resection patients had better median OS, compared with patients with R1 resection or not resected (65.5 months vs. 15.5 months, p = 0.01). N0 rate among the resected patients was 63.1%, and showed a longer median OS (65.5 vs. 15.2 months, p = 0.009). CONCLUSION: The results of this study confirm promising oncologic results with NAT for patients with resectable PDAC. Therefore, the present trial supports the development of phase II randomized trials comparing NAT vs. upfront surgery in resectable pancreatic cancer.


Assuntos
Adenocarcinoma/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Desoxicitidina/análogos & derivados , Cloridrato de Erlotinib/uso terapêutico , Terapia Neoadjuvante/métodos , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/radioterapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/uso terapêutico , Esquema de Medicação , Cloridrato de Erlotinib/administração & dosagem , Feminino , Humanos , Masculino , Pancreatectomia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/radioterapia , Radioterapia Adjuvante , Análise de Sobrevida
3.
Cir Esp ; 95(8): 447-456, 2017 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28992935

RESUMO

INTRODUCTION: A borderline resectable group (APBR) has recently been defined in adenocarcinoma of the pancreas. The objective of the study is to evaluate the results in the surgical treatment after neoadjuvancy of the APBR. METHOD: Between 2010 and 2014, we included patients with APBR in a neoadjuvant and surgery protocol, staged by multidetector computed tomography (MDCT). Treatment with chemotherapy was based on gemcitabine and oxaliplatin. Subsequently, MDCT was performed to rule out progression, and 5-FU infusion and concomitant radiotherapy were given. MDCT and resection were performed in absence of progression. A descriptive statistical study was performed, dividing the series into: surgery group (GR group) and progression group (PROG group). RESULTS: We indicated neoadjuvant treatment to 22 patients, 11 of them were operated, 9 pancreatoduodenectomies, and 2 distal pancreatectomies. Of the 11 patients, 7 required some type of vascular resection; 5 venous resections, one arterial and one both. No postoperative mortality was recorded, 7 (63%) had any complications, and 4 were reoperated. The median postoperative stay was 17 (7-75) days. The pathological study showed complete response (ypT0) in 27%, and free microscopic margins (R0) in 63%. At study clossure, all patients had died, with a median actuarial survival of 13 months (9,6-16,3). The median actuarial survival of the GR group was higher than the PROG group (25 vs. 9 months; p < 0.0001). CONCLUSION: The neoadjuvant treatment of APBR allows us to select a group of patients in whom resection achieves a longer survival to the group in which progression is observed. Post-adjuvant pancreatic resection requires vascular resection in most cases.


Assuntos
Adenocarcinoma/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante
4.
Cir. Esp. (Ed. impr.) ; 95(8): 447-456, oct. 2017. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-167531

RESUMO

Introducción: Se ha definido un grupo de resecabilidad borderline resectable (APBR) en el adenocarcinoma de páncreas. El objetivo del estudio es evaluar los resultados en el tratamiento quirúrgico tras neoadyuvancia del APBR. Método: Entre 2010 y 2014 incluimos pacientes afectos de APBR en un protocolo de neoadyuvancia y cirugía, estadificados mediante tomografía computarizada multidetector (TCMD). El tratamiento con quimioterapia se basó en gemcitabina y oxaliplatino (GEMOX). Posteriormente, se realizó TCMD para descartar progresión, y se administró 5-FU en infusión y radioterapia concomitante. Se practicó TCMD y resección en ausencia de progresión. Se realizó un estudio estadístico descriptivo, dividiendo la serie en grupo resección (grupo GR) y grupo progresión (grupo PROG). El seguimiento finalizó en febrero de 2016. Resultados: Indicamos tratamiento neoadyuvante a 22 pacientes, 11 de ellos fueron finalmente intervenidos. Se realizaron 9 duodenopancreatectomías cefálicas, una duodenopancreatectomía total y una pancreatectomía corporocaudal. De los 11 pacientes, 7 requirieron algún tipo de resección vascular; 5 resecciones venosas, uno arterial y otro ambas. No hubo mortalidad postoperatoria, 7 (63%) tuvieron alguna complicación y 4 fueron reintervenidos. La estancia hospitalaria postoperatoria mediana fue 17 días (7-75). El estudio patológico evidenció márgenes microscópicos libres (R0) en el 63% de los pacientes y ausencia de afectación adenopática en 10 pacientes (ypN0). Al cierre del estudio, todos los pacientes habían fallecido, con una supervivencia actuarial mediana de 13 meses (9,6-16,3). La supervivencia actuarial mediana del grupo GR fue superior al grupo PROG (25 vs. 9 meses; p<0,0001). Conclusión: El tratamiento neoadyuvante del APBR permite seleccionar un grupo de pacientes en el que la resección consigue una supervivencia superior al grupo en el que se observa progresión. La resección pancreática posneoadyuvancia requiere resecciones vasculares en la mayoría de los casos (AU)


Introduction: A borderline resectable group (APBR) has recently been defined in adenocarcinoma of the pancreas. The objective of the study is to evaluate the results in the surgical treatment after neoadjuvancy of the APBR. Method: Between 2010 and 2014, we included patients with APBR in a neoadjuvant and surgery protocol, staged by multidetector computed tomography (MDCT). Treatment with chemotherapy was based on gemcitabine and oxaliplatin. Subsequently, MDCT was performed to rule out progression, and 5-FU infusion and concomitant radiotherapy were given. MDCT and resection were performed in absence of progression. A descriptive statistical study was performed, dividing the series into: surgery group (GR group) and progression group (PROG group). Results: We indicated neoadjuvant treatment to 22 patients, 11 of them were operated, 9 pancreatoduodenectomies, and 2 distal pancreatectomies. Of the 11 patients, 7 required some type of vascular resection; 5 venous resections, one arterial and one both. No postoperative mortality was recorded, 7 (63%) had any complications, and 4 were reoperated. The median postoperative stay was 17 (7-75) days. The pathological study showed complete response (ypT0) in 27%, and free microscopic margins (R0) in 63%. At study clossure, all patients had died, with a median actuarial survival of 13 months (9,6-16,3). The median actuarial survival of the GR group was higher than the PROG group (25 vs. 9 months; p < 0.0001). Conclusion: The neoadjuvant treatment of APBR allows us to select a group of patients in whom resection achieves a longer survival to the group in which progression is observed. Post-adjuvant pancreatic resection requires vascular resection in most cases (AU)


Assuntos
Humanos , Neoplasias Pancreáticas/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Terapia Neoadjuvante/métodos , Pancreatectomia/métodos , Estudos Prospectivos , Endossonografia/métodos , Estadiamento de Neoplasias/métodos
5.
Cir. Esp. (Ed. impr.) ; 94(9): 518-524, nov. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-157302

RESUMO

INTRODUCCIÓN: Actualmente, el único tratamiento curativo de la recurrencia pélvica del cáncer de recto es la resección radical. El objetivo de este trabajo es realizar un análisis de nuestra experiencia en la cirugía de la recidiva local del cáncer de recto. MÉTODOS: Realizamos un análisis descriptivo retrospectivo de los pacientes intervenidos con intención curativa por recidiva local de cáncer recto desde mayo de 2000 hasta enero de 2014. La presencia de metástasis hepáticas o pulmonares resecables no fue criterio de exclusión. Se presentan los resultados descriptivos y los tiempos de supervivencia y libres de enfermedad. RESULTADOS: Se incluyó a 35 pacientes. En 18 pacientes se realizó una amputación del remanente del recto, en 2 de ellos con exéresis de vértebras sacras inferiores, y en 17 pacientes se realizó cirugía preservadora de esfínteres. Las complicaciones postoperatorias más frecuentes fueron la colección pélvica y el íleo paralítico postoperatorio. Siete pacientes requirieron reintervención y uno falleció. La supervivencia global al año fue del 91,2%, a los 2 años del 75,6% y a los 5 años del 37%. CONCLUSIONES: La recidiva local del cáncer de recto es una enfermedad con alta tasa de curabilidad. La única opción curativa es la cirugía radical, con una mortalidad aceptable


INTRODUCTION: The only curative treatment of pelvic recurrence of rectal cancer is radical resection. The aim of this paper is to analyze our experience in surgery for local recurrence of rectal cancer. METHODS: We performed a descriptive retrospective analysis of patients treated with curative intent for local recurrence of rectal cancer from May 2000 to January 2014. The presence of resectable liver or lung metastases was not an exclusion criterion. The descriptive results, overall survival and disease free survival are presented. RESULTS: A total of 35 patients were included. In 18 patients an abdomino-perineal resection of the remaining rectum was performed. Two of them included excision of lower sacral vertebrae, while in 17 patients, sphincter sparing surgery was performed. The most frequent postoperative complications were pelvic collection and postoperative ileus. Seven patients required reoperation and one patient died. Overall survival at one year was 91.2%, at 2 years 75.6% and at 5 years 37%. CONCLUSIONS: Local recurrence of rectal cancer is a disease with high curability rate. The only curative option is radical surgery, with acceptable mortality


Assuntos
Humanos , Neoplasias Retais/cirurgia , Neoplasias Pélvicas/cirurgia , Resultado do Tratamento , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Metástase Neoplásica/patologia , Quimiorradioterapia
6.
Cir Esp ; 94(9): 518-524, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27639620

RESUMO

INTRODUCTION: The only curative treatment of pelvic recurrence of rectal cancer is radical resection. The aim of this paper is to analyze our experience in surgery for local recurrence of rectal cancer. METHODS: We performed a descriptive retrospective analysis of patients treated with curative intent for local recurrence of rectal cancer from May 2000 to January 2014. The presence of resectable liver or lung metastases was not an exclusion criterion. The descriptive results, overall survival and disease free survival are presented. RESULTS: A total of 35 patients were included. In 18 patients an abdomino-perineal resection of the remaining rectum was performed. Two of them included excision of lower sacral vertebrae, while in 17 patients, sphincter sparing surgery was performed. The most frequent postoperative complications were pelvic collection and postoperative ileus. Seven patients required reoperation and one patient died. Overall survival at one year was 91.2%, at 2 years 75.6% and at 5 years 37%. CONCLUSIONS: Local recurrence of rectal cancer is a disease with high curability rate. The only curative option is radical surgery, with acceptable mortality.


Assuntos
Adenocarcinoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Pélvicas/cirurgia , Neoplasias Retais/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Encaminhamento e Consulta , Estudos Retrospectivos , Resultado do Tratamento
7.
BMC Cancer ; 15: 59, 2015 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-25886275

RESUMO

BACKGROUND: To evaluate whether the addition of bevacizumab (BVZ) to capecitabine-based chemoradiotherapy in the preoperative treatment of locally advanced rectal cancer (LARC) improves efficacy measured by the pathological complete response (pCR) rate. METHODS: A phase II two-step design was performed. Patients received four cycles of therapy consisting of: BVZ 10 mg/kg in first infusion on day 1 and 5 mg/kg on days 15, 29, 43, capecitabine 1800 mg/m(2)/day 5 days per week during radiotherapy, which consisted of external-beam irradiation (45 Gy in 1.8 Gy dose per session over 5 sessions/week for 5 weeks). Six to eight weeks after completion of all therapies surgery was undergone. To profile the biological behaviour during BVZ treatment we measured molecular biomarkers before treatment, during BVZ monotherapy, and during and after combination therapy. Microvessel density (MVD) was measured after surgery. RESULTS: Forty-three patients were assessed and 41 were included in the study. Three patients achieved a pathological complete response (3/40: 7.5%) and 27 (67.5%) had a pathological partial response, (overall pathological response rate of 75%). A further 8 patients (20%) had stable disease, giving a disease control rate of 95%. Downstaging occurred in 31 (31/40: 77.5%) of the patients evaluated. This treatment resulted in an actuarial 4-year disease-free and overall survival of 85.4 and 92.7% respectively. BVZ with chemoradiotherapy showed acceptable toxicity. No correlations were observed between biomarker results and efficacy variables. CONCLUSION: BVZ with capecitabine and radiotherapy seem safe and active and produce promising survival results in LARC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00847119 . Trial registration date: February 18, 2009.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Capecitabina/administração & dosagem , Quimiorradioterapia Adjuvante/métodos , Neoplasias Retais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Capecitabina/uso terapêutico , Fracionamento da Dose de Radiação , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Neoplasias Retais/patologia , Análise de Sobrevida , Resultado do Tratamento
8.
Clin Transl Oncol ; 14(2): 132-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22301402

RESUMO

INTRODUCTION: The aim of this study is to determine the interobserver variability (IV) between radiation oncologists (RO) in target volume delineation for postoperative gastric cancer (GC) radiotherapy planning. MATERIALS AND METHODS: Four physicians were asked to delimitate clinical target volume (CTV) on the same 3D CT images in 9 postoperative radiochemotherapy GC patients. Instructions were given to include tumour bed, remaining stomach, anastomosis, duodenal loop and local lymph nodes. The principal variable was spatial volume discrepancy between the main observer (called "A") and other observers (all called "B"), which were compared using the mathematical formula A⌣B/A⌢B, applied to the 3D CT images using Boolean operators. Analysis of variance with two random effects (observers and patients) was performed. RESULTS: Mean volumes were 1410 cm(3) for OBA, 1231 cm(3) for OB2, 734.6 cm(3) for OB3 and 1350 cm(3) for OB4. Discrepancies were 519.9±431.6 cm(3) for OB2, 652.1±294.36 cm(3) for OB3 and 225.90±237.07 cm(3) for OB4. Standard deviation ascribed to patients as random effect was 898.6 cm(3) and that ascribed to observers was 198.10 cm(3), considered as a statistically significant difference. CONCLUSIONS: A significant IV in target delineation that can be attributed to many factors depends more on patients' characteristics than RO delineating decisions.


Assuntos
Quimiorradioterapia , Variações Dependentes do Observador , Padrões de Prática Médica , Radioterapia (Especialidade) , Planejamento da Radioterapia Assistida por Computador , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Projetos Piloto , Prognóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios X
9.
Clin Transl Oncol ; 13(7): 472-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21775274

RESUMO

OBJECTIVES: The aim of this study was to retrospectively evaluate clinical characteristics, local control, acute and late toxicity, and prognostic factors of patients with anal canal carcinoma treated with brachytherapy. METHODS: From 1989 to 2009, 38 patients were treated with iridium 192 low-dose-rate (N = 26) or pulsed-dose-rate (N = 12) interstitial brachytherapy at a single institution. The median age was 62 years (range, 38-86 years). The TNM classification was as follows: 10 T1, 22 T2, 5 T3 and 1 T4; 32 N0, 3 N1 and 3 N2. Most patients (32/38) received either a first course of radiochemotherapy (N = 22) or radiotherapy alone (N=10) consisting of a total delivered dose of 45 Gy to the pelvis (range, 32-50) followed by a boost a median of 18 days later of 15-35 Gy (median 20 Gy) to the anal canal. The remaining 6 cases were treated with brachytherapy alone (dose range, 60-65 Gy). RESULTS: With a median follow-up of 30 months (range, 4-200), 2- and 5-year local control rates were 91% and 87%, respectively. Preservation of the anal sphincter was achieved in 32 patients (84%). Three patients experienced incontinence after brachytherapy. Only 2 patients showed chronic mucositis grade 3/4. Age proved to be a statistically significant prognostic factor for overall survival in the univariate (p = 0.033) and multivariate analyses (p = 0.018). Concurrent chemotherapy with external beam radiotherapy was a statistically significant prognostic factor for disease-free survival in the univariate and multivariate analyses (p = 0.007 and p = 0.044, respectively). CONCLUSIONS: Interstitial brachytherapy appears to be an effective and well tolerated treatment for anal carcinoma offering both high local tumour control and anal sphincter preservation.


Assuntos
Neoplasias do Ânus/radioterapia , Braquiterapia , Carcinoma de Células Escamosas/radioterapia , Radioisótopos de Irídio/uso terapêutico , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
10.
Cir. Esp. (Ed. impr.) ; 88(6): 374-382, dic. 2010. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-135843

RESUMO

Objetivo: Definir factores pronóstico de supervivencia a largo plazo tras la duodenopancreatectomía cefálica por adenocarcinoma pancreático. Introducción: La cirugía es el tratamiento aceptado en el adenocarcinoma de páncreas cefálico, sin embargo la supervivencia a largo plazo sigue siendo baja. Material y métodos: Hemos recogido la experiencia en el tratamiento del adenocarcinoma de cabeza de páncreas (ADCP) en el Hospital Universitari de Bellvitge mediante duodenopancreatectomía cefálica (DPC) desde 1991 hasta 2007. Resultados: Se realizaron 204 DPC por ADCP. El estudio histológico evidenció que el tumor resecado tenía un tamaño superior a 3cm. en 70, con permeación linfática en un 73%, invasión perineural en 89% y afectación linfática en 71%. En 120 pacientes se resecaron más de 15 adenopatías. Tras la cirugía, se administró tratamiento adyuvante a 113 pacientes (60%). Se contabilizaron 148 fallecimientos (73%), estando vivos al cierre del mismo 55 (27%). La supervivencia actual media fue de 2,54 años (IC95% 2,02–3,07) y la supervivencia actuarial a 5 años de 13,55% (IC95% 7,69–19,41). El estudio de factores de riesgo de mortalidad reveló que el sexo femenino (p=0,005), la ausencia de transfusión perioperatoria (p=0,003), la resección de más de 15 adenopatías en la intervención (p=0,004) y la administración de tratamiento adyuvante (p=0,004) comportaron mejor pronóstico a largo plazo. El estudio multivariante demostró que transfusión y sexo fueron las variables de interés. Conclusiones: La cirugía del adenocarcinoma de cabeza de páncreas debe incluir una linfadenectomía suficiente y debe realizarse con baja morbilidad y sin necesidad de transfusión perioperatoria (AU)


Introduction: Surgery is the accepted treatment in adenocarcinoma of the head of the pancreas; however, the long-term survival continues to be low. The aim of this study is to define prognos:tic factors of long-term survival after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma. Material and methods: We have collected data on the treatment of adenocarcinoma of the head of the pancreas (ADHP) by means of a cephalic duodenopancreatectomy (CDP) performed n the Bellvitge University Hospital (Barcelona) from 1991 to 2007. Results: A total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3cms in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02–3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69–19.41). The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion (p=0.003), the resection of more than 15 lymph nodes during the operation (P=0.004), and the administration of adjuvant treatment (p=0.004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables. Conclusions: Surgery of head of the pancreas adenocarcinoma must include an adequate lymphadectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Seguimentos , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
11.
Cir Esp ; 88(6): 374-82, 2010 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21030012

RESUMO

INTRODUCTION: Surgery is the accepted treatment in adenocarcinoma of the head of the pancreas; however, the long-term survival continues to be low. The aim of this study is to define prognostic factors of long-term survival after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma. MATERIAL AND METHODS: We have collected data on the treatment of adenocarcinoma of the head of the pancreas (ADHP) by means of a cephalic duodenopancreatectomy (CDP) performed n the Bellvitge University Hospital (Barcelona) from 1991 to 2007. RESULTS: A total of 204 CDP due to ADHP were performed. The histology showed that the resected tumour was larger than 3cms in 70 cases, with lymphatic infiltration in 73%, perineural invasion in 89%, and lymphatic involvement in 89%. More than 15 lymph nodes were resected in 120 patients. A total of 113 (60%) patients received adjuvant treatment after surgery. There were 148 (73%) deaths, of which 55 (27%) were alive at closure. The actual mean survival was 2.54 years (95% CI; 2.02-3.07) and an actuarial survival at 5 years of 13.55% (95% CI; 7.69-19.41). The study of mortality risk factors showed that, female gender, absence of peri-operative transfusion (p=0.003), the resection of more than 15 lymph nodes during the operation (P=0.004), and the administration of adjuvant treatment (p=0.004) had a better long-term prognosis. The multivariate analysis showed that transfusion and gender were the most significant variables. CONCLUSIONS: Surgery of head of the pancreas adenocarcinoma must include an adequate lymphadectomy, and must be performed with a low morbidity and without the need of a peri-operative transfusion.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/mortalidade , Idoso , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/métodos , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
12.
J Negat Results Biomed ; 5: 15, 2006 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-17062130

RESUMO

BACKGROUND: Chronic inflammation is a risk factor for colorectal cancer and polymorphisms in the inflammatory genes could modulate the levels of inflammation. We have investigated ten single nucleotide polymorphisms (SNPs) in the following inflammation-related genes: TLR4 (Asp299Gly), CD14 (-260 T>C), MCP1 (-2518 A>G), IL12A (+7506 A>T, +8707 A>G, +9177 T>A, +9508 G>A), NOS2A (+524T>C), TNF (-857C>T), and PTGS1 (V444I) in 377 colorectal (CRC) cancer cases and 326 controls from Barcelona (Spain). RESULTS: There was no statistically significant association between the SNPs investigated and colorectal cancer risk. CONCLUSION: The lack of association may show that the inflammatory genes selected for this study are not involved in the carcinogenic process of colorectum. Alternatively, the negative results may derive from no particular biological effect of the analysed polymorphisms in relation to CRC. Otherwise, the eventual biological effect is so little to go undetected, unless analysing a much larger sample size.


Assuntos
Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Mediadores da Inflamação/metabolismo , Polimorfismo Genético , Predisposição Genética para Doença , Genótipo , Humanos , Inflamação/genética
13.
Cancer Epidemiol Biomarkers Prev ; 14(7): 1633-8, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16030094

RESUMO

Sporadic colorectal cancer is considered a multifactorial disease in which multiple exposures interact with the individual genetic background resulting in risk modulation. Recent experimental data suggest a role of dopamine and dopamine receptors in the control of proliferation of the cells of colon and gastrointestinal tract. To investigate whether polymorphisms within dopamine receptors genes could have a role in modulating the risk of sporadic colorectal cancer, we did a case-control association study and genotyped 370 cases and 327 controls for seven single-nucleotide polymorphisms (SNP) of DRD2 (-141Cdel, 957T>C, TaqIB, TaqIA, 1412A>G, S311C, and 3208G>T) by a microarray-based technique. Three SNPs within DRD2 were associated with colorectal cancer, with a maximum odds ratio of 2.28 (95% confidence interval, 1.38-3.76) for carriers of the functional SNP -141Cdel. The haplotype which includes -141Cdel, together with the variants 957C and 1412G, shows an odds ratio of 2.86 (95% confidence interval, 1.58-5.18), as compared with the most frequent haplotype. The SNPs within DRD2 associated with colorectal cancer are known to be related to reduced levels of D2 dopamine receptor. Thus, our data point to a possible role of dopamine receptor DRD2 in modulating the risk of colorectal cancer. Future studies on dopamine receptor-mediated signal transduction may provide new insight into the mechanisms of colorectal cancer and suggest new therapeutic strategies.


Assuntos
Neoplasias Colorretais/genética , Receptores de Dopamina D2/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético
14.
J Epidemiol Community Health ; 59(6): 506-11, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15911648

RESUMO

BACKGROUND: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. OBJECTIVE: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. DESIGN: Prospective cohort study. SETTING: Hospital Universitary in L'Hospitalet (Barcelona, Spain). PARTICIPANTS: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and METHODS: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. RESULTS: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes's stage, mortality, and Charlson's index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). CONCLUSIONS: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients.


Assuntos
Neoplasias Colorretais/terapia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Neoplasias Colorretais/patologia , Terapia Combinada , Escolaridade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco , Fatores Sexuais , Espanha
15.
Med Clin (Barc) ; 123(8): 291-6, 2004 Sep 11.
Artigo em Espanhol | MEDLINE | ID: mdl-15373975

RESUMO

BACKGROUND AND OBJECTIVE: Colorectal cancer is one of the most frequent causes of death in the general population. Our aim was to analyze our experience in the multidisciplinary approach of colorectal carcinoma during a three year period. PATIENTS AND METHOD: Between January 1996 and December 1998, we studied prospectively 807 patients with colorectal cancer. The epidemiology, treatment and outcome(recurrence and survival) were analyzed. The minimum follow-up was 3 years. RESULTS: There were 598 colon (65.5%) and 279 rectal (34.5%) tumors in all the series. Surgical treatment was elective in 84% and urgent in 16%, and was considered radical in 598 cases (74.1%). Chemotherapy or radiotherapy was administered in 49.6% and 18.3% patients, respectively. The overall 3-year survival was as follows: stage I 97.5%, stage II 90.6%, stage III 75.2%, and stage IV 12.6%. The 3-year free-disease survival was as follows: in colon cancer 97.8% for stage I, 87.3% for stage II, and 71.4% for stage III; and in rectal cancer 96.8% for stage I, 85.1% for stage II, and 75.4% for stage III. During the follow-up 124 patients (20.7%) developed recurrence: local (2.8%), systemic (15.9%) or both (2%). The three-year survival in operated patients with liver metastases was 61.9%. CONCLUSIONS: We have observed adequate survival and recurrence rates which are the result are of systematic protocols established by a multidisciplinary team.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida
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