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1.
Med Oncol ; 39(12): 224, 2022 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-36175723

RESUMO

Gastric cancer represents one of the leading causes of cancer-related death worldwide. Even if the last decade has witnessed an improvement in surgical and systemic treatments, with an increase of overall life expectancy, survival rates still remain unsatisfactory, especially for patients with metastatic disease. Systemic therapies represent the gold standard in the management of stage IV gastric cancer. In this scenario, the availability of effective second and third lines has represented for a long time the only hope to offer an overall survival improvement to these patients. Recently, the advent of immune checkpoint inhibitors has involved also gastric cancer with encouraging efficacy data in the metastatic setting, becoming integral part of the management of selected patients.


Assuntos
Neoplasias Esplênicas , Neoplasias Gástricas , Humanos , Inibidores de Checkpoint Imunológico , Fatores Imunológicos , Imunoterapia , Neoplasias Gástricas/terapia
2.
Nutrition ; 93: 111487, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34655953

RESUMO

OBJECTIVES: The hospital catering service plays a decisive role in responding to clinical and nutritional needs and in providing food that is acceptable to patients. Unfortunately, at the moment, most hospital catering services provide a service deemed insufficient by users and are burdened by a high proportion of food waste that may negatively affect the nutritional and clinical status of patients. The aim of this study was to verify the efficacy of the NI-Nutritional Intelligence project in improving the nutritional and sensorial quality of hospital meals. METHODS: The study was conducted in the Cristo Re Hospital of Rome (Italy), where two different cooking techniques were compared: traditional procedures and the low-aggression gastronomic procedures of the Niko Romito Food Processing Technique. Data were collected on both objective (food waste) and subjective (customer satisfaction) evaluations of the food service. RESULTS: The proportion of participants wasting at least 50% of dishes served dropped from 25.9% to 20% for the first course, from 32.8% to 20% for the main course, and from 29.3% to 20.4% for the side (P < 0.05 in all cases). Regarding customer satisfaction, the percentage of participants who gave a positive opinion on the variety of the menus gradually increased from 74.1% to 95% (P < 0.05). The same happened for opinions concerning the presentation of the dishes (smell, color, flavor): positive judgments went from 51.7% to 76% (P < 0.05). The overall scoring of the food service (0-10) went from 6.38 ± 2.3 to 7.6 ± 2.1 (P < 0.05). CONCLUSION: The hospital catering service must be able to provide patients with meals with an adequate supply of energy and nutrients to allow them to recover their health and reduce hospital stays. The Nutritional Intelligence project, based on the gastronomic method proposed in the Niko Romito Food Processing Technique, significantly reduces food waste and improves customer satisfaction without imposing service costs related to catering staff and foodstuffs.


Assuntos
Serviço Hospitalar de Nutrição , Eliminação de Resíduos , Culinária , Hospitais , Humanos , Refeições
3.
Cancer Med ; 10(18): 6354-6364, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34374489

RESUMO

BACKGROUND: Docetaxel (D) or secondary hormonal therapy (SHT) each combined with androgen deprivation therapy (ADT) represent possible treatment options in males with metastasized hormone-sensitive prostate cancer (mHSPC). Real-world data comparing different protocols are lacking yet. Thus, our objective was to compare the efficacy and safety of abiraterone acetate (AA)+ADT versus D+ADT in mHSPC. METHODS: In a retrospective multicenter analysis including males with mHSPC treated with either of the aforementioned protocols, overall survival (OS), progression-free survival 1 (PFS1), and progression-free survival 2 (PFS2) were assessed for both cohorts. Median time to event was tested by Kaplan-Meier method and log-rank test. The Cox-proportional hazards model was used for univariate and multivariate regression analyses. RESULTS: Overall, 196 patients were included. The AA+ADT cohort had a longer PFS1 in the log-rank testing (23 vs. 13 mos., p < 0.001), a longer PFS2 (48 vs. 33 mos., p = 0.006), and longer OS (80 vs. 61 mos., p = 0.040). In the multivariate analyses AA+ADT outperformed D+ADT in terms of PFS1 (HR = 0.34, 95% CI = 0.183-0.623; p = 0.001) and PFS2 (HR = 0.33 95% CI = 0.128-0.827; p = 0.018), respectively, while OS and toxicity rate were similar between both groups. CONCLUSIONS: AA+ADT is mainly associated with a similar efficacy and overall toxicity rate as D+ADT. Further prospective research is required for validation of the clinical value of the observed benefit of AA+ADT for progression-free end-points.


Assuntos
Acetato de Abiraterona/uso terapêutico , Antagonistas de Androgênios/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Docetaxel/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Estudos Retrospectivos
4.
Eur Urol Focus ; 7(6): 1308-1315, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32653263

RESUMO

BACKGROUND: Besides second-generation hormone therapy (sHT), upfront docetaxel along with androgen deprivation therapy is the current standard of care for metastasized hormone-sensitive prostate cancer (mHSPC). Evidence on second-line therapy upon progression on chemohormonal treatment outside clinical trials is scarce. OBJECTIVE: To comparatively assess the efficacy of subsequent therapy after upfront docetaxel in mHSPC in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective multicenter analysis. Males with mHSPC on androgen-deprivation therapy progressed to castration-resistant prostate cancer (CRPC) after upfront docetaxel. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS), progression-free survival 2 (PFS2), and time to progression 2 (TTP2) were assessed. Chi-square test and Mann-Whitney U test were used for univariate comparison between the sHT and non-sHT (other therapies) cohorts. Median time to event was tested by Kaplan-Meier method and log-rank test. Univariate and multivariate analysis regression was performed with the Cox proportional-hazard model. RESULTS AND LIMITATIONS: Sixty-five patients were included in the final analysis. Median TTP2 was 20 mo, median PFS2 was 29 mo, and median OS was not reached; sHT was an independent predictor of favorable PFS2 as compared with non-sHT. Time to CRPC was also confirmed to be the strongest predictor for novel endpoints PFS2 and TTP2. Time to CRPC >18 mo conferred advantage to sHT over non-sHT in relation to PFS2 and OS. Second-line therapies were well tolerated. The analysis is prone to inherent flaws and biases due to its retrospective nature. CONCLUSIONS: In real-world patients progressing after upfront docetaxel, sHT is independently associated with favorable PFS2 favoring drug class switch. Longer time to CRPC predicts strongly for superior PFS2 and TTP2. Further prospective research is warranted in order to guide treatment sequencing and improve outcomes and quality of life of males with metastasized prostate cancer. PATIENT SUMMARY: We analyzed the efficacy of second-line therapy after docetaxel in hormone-dependent metastatic prostate cancer. Novel hormone therapy appears to be a preferable option for deferring progression optimally. Larger patient databases are eagerly awaited.


Assuntos
Segunda Neoplasia Primária , Neoplasias de Próstata Resistentes à Castração , Antagonistas de Androgênios/uso terapêutico , Androgênios/uso terapêutico , Docetaxel/uso terapêutico , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/patologia , Qualidade de Vida , Estudos Retrospectivos
5.
Strahlenther Onkol ; 196(3): 243-251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31586231

RESUMO

PURPOSE: An increase of skin dose during head and neck cancer (HNC) radiotherapy is potentially dangerous. Aim of this study was to quantify skin dose variation and to assess the need of planning adaptation (ART) to counteract it. METHODS: Planning CTs of 32 patients treated with helical tomotherapy (HT) according to a Simultaneous Integrated Boost (SIB) technique delivering 54/66 Gy in 30 fractions were deformably co-registered to MVCTs taken at fractions 15 and 30; in addition, the first fraction was also considered. The delivered dose-of-the-day was calculated on the corresponding deformed images. Superficial body layers (SL) were considered as a surrogate for skin, considering a layer thickness of 2 mm. Variations of SL DVH (∆SL) during therapy were quantified, focusing on ∆SL95% (i.e., 62.7 Gy). RESULTS: Small changes (within ± 1 cc for ∆SL95%) were seen in 15/32 patients. Only 2 patients experienced ∆SL95% > 1 cc in at least one of the two monitored fractions. Negative ∆SL95% > 1 cc (up to 17 cc) were much more common (15/32 patients). The trend of skin dose changes was mostly detected at the first fraction. Negative changes were correlated with the presence of any overlap between PTV and SL at planning and were explained in terms of how the planning system optimizes the PTV dose coverage near the skin. Acute toxicity was associated with planning DVH and this association was not improved if considering DVHs referring to fractions 15/30. CONCLUSION: About half of the patients treated with SIB with HT for HNC experienced a skin-sparing effect during therapy; only 6% experienced an increase. Our findings do not support skin-sparing ART, while suggesting the introduction of improved skin-sparing planning techniques.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Pele/efeitos da radiação , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Planejamento da Radioterapia Assistida por Computador/métodos , Pele/diagnóstico por imagem , Pele/patologia , Tomografia Computadorizada por Raios X
6.
Lancet Oncol ; 15(7): 713-21, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24831979

RESUMO

BACKGROUND: An established multivariate serum protein test can be used to classify patients according to whether they are likely to have a good or poor outcome after treatment with EGFR tyrosine-kinase inhibitors. We assessed the predictive power of this test in the comparison of erlotinib and chemotherapy in patients with non-small-cell lung cancer. METHODS: From Feb 26, 2008, to April 11, 2012, patients (aged ≥18 years) with histologically or cytologically confirmed, second-line, stage IIIB or IV non-small-cell lung cancer were enrolled in 14 centres in Italy. Patients were stratified according to a minimisation algorithm by Eastern Cooperative Oncology Group performance status, smoking history, centre, and masked pretreatment serum protein test classification, and randomly assigned centrally in a 1:1 ratio to receive erlotinib (150 mg/day, orally) or chemotherapy (pemetrexed 500 mg/m(2), intravenously, every 21 days, or docetaxel 75 mg/m(2), intravenously, every 21 days). The proteomic test classification was masked for patients and investigators who gave treatments, and treatment allocation was masked for investigators who generated the proteomic classification. The primary endpoint was overall survival and the primary hypothesis was the existence of a significant interaction between the serum protein test classification and treatment. Analyses were done on the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT00989690. FINDINGS: 142 patients were randomly assigned to chemotherapy and 143 to erlotinib, and 129 (91%) and 134 (94%), respectively, were included in the per-protocol analysis. 88 (68%) patients in the chemotherapy group and 96 (72%) in the erlotinib group had a proteomic test classification of good. Median overall survival was 9·0 months (95% CI 6·8-10·9) in the chemotherapy group and 7·7 months (5·9-10·4) in the erlotinib group. We noted a significant interaction between treatment and proteomic classification (pinteraction=0·017 when adjusted for stratification factors; pinteraction=0·031 when unadjusted for stratification factors). Patients with a proteomic test classification of poor had worse survival on erlotinib than on chemotherapy (hazard ratio 1·72 [95% CI 1·08-2·74], p=0·022). There was no significant difference in overall survival between treatments for patients with a proteomic test classification of good (adjusted HR 1·06 [0·77-1·46], p=0·714). In the group of patients who received chemotherapy, the most common grade 3 or 4 toxic effect was neutropenia (19 [15%] vs one [<1%] in the erlotinib group), whereas skin toxicity (one [<1%] vs 22 [16%]) was the most frequent in the erlotinib group. INTERPRETATION: Our findings indicate that serum protein test status is predictive of differential benefit in overall survival for erlotinib versus chemotherapy in the second-line setting. Patients classified as likely to have a poor outcome have better outcomes on chemotherapy than on erlotinib. FUNDING: Italian Ministry of Health, Italian Association of Cancer Research, and Biodesix.


Assuntos
Proteínas Sanguíneas/análise , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Proteômica , Quinazolinas/uso terapêutico , Biomarcadores Tumorais , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Intervalo Livre de Doença , Receptores ErbB/genética , Cloridrato de Erlotinib , Feminino , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/mortalidade , Masculino
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