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1.
Medicine (Baltimore) ; 100(19): e25873, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106639

RESUMO

BACKGROUND: Osteoarthritis of the knee is one of the leading causes of pain and disability among adults. Thermotherapy has been widely used to treat knee osteoarthritis. But its efficiency has not been scientifically and methodically evaluated. The aim of this study is to assess the benefits of thermotherapy for people with osteoarthritis of the knee, in terms of pain, stiffness, and physical dysfunction. METHODS: Eight databases will be searched from their inception to September 2020. They are as follows: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, China Knowledge Resource Integrated Database (CNKI), Weipu Database for Chinese Technical Periodicals (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. RESULTS: The systematic review will provide high-quality evidence to assess the benefits and harms of thermotherapy for people with osteoarthritis of the knee, in terms of pain, stiffness, and dysfunction of knee joint, and quality of life, as well as adverse events. CONCLUSION: The systematic review will provide evidence to assess the effectiveness and safety of thermotherapy for knee osteoarthritis patients. INPLASY REGISTRATION NUMBER: INPLASY202140038.


Assuntos
Hipertermia Induzida/métodos , Osteoartrite do Joelho/terapia , Humanos , Hipertermia Induzida/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Índice de Gravidade de Doença
2.
J Pak Med Assoc ; 71(6): 1686-1688, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34111099

RESUMO

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. A diagnosis of Stress-induced Cardiomyopathy was established using InterTAK Diagnostic Score. Patients with CRS-HIPEC have presented with Stress-induced Cardiomyopathy. However, no specific relation between the two has been established. This case report discusses Stress-induced Cardiomyopathy as a complication of CRS-HIPEC.


Assuntos
Hipertermia Induzida , Neoplasias Peritoneais , Pseudomixoma Peritoneal , Adulto , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneais/terapia , Pseudomixoma Peritoneal/tratamento farmacológico
3.
Scand J Urol ; 55(4): 281-286, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34124993

RESUMO

INTRODUCTION: Non-muscle invasive bladder cancer (NMIBC) is one of the most frequent neoplasms in Denmark. Treatment of high-risk NMIBC usually consists of transurethral resection of bladder (TUR-B) followed by intravesical Bacillus Calmette-Guérin (BCG) instillations. Unfortunately, some patients are BCG-unresponsive and will relapse over time. Radical cystectomy is the recommended salvage treatment following BCG-failure or BCG-intolerance. However, not all patients are candidates for surgery and thus, in need of other treatment. This study investigates the adverse events of Hyperthermic Intravesical Chemotherapy (HIVEC) treatment. METHODS: Twenty-three high-risk NMIBC patients, who were BCG-unresponsive or had contraindications for BCG, received HIVEC with Mitomycin C. Prior to each instillation, patients were interviewed by a nurse, using a systematic questionnaire regarding the adverse events. Patients were followed with cytology and cystoscopy every fourth month. The primary outcome was adverse event related to the HIVEC treatment. RESULTS: In general, the adverse events were mild to moderate and often self-limiting. The most common adverse events were urinary frequency (23.6%), incontinence (19.4%) and urinary tract pain (12.2%). CONCLUSION: In the current study, we found that HIVEC was a well-tolerated treatment. HIVEC might be a feasible option for patients, who experienced BCG-failure or BCG-intolerance and could potentially postpone or avoid radical cystectomy.


Assuntos
Hipertermia Induzida , Neoplasias da Bexiga Urinária , Administração Intravesical , Vacina BCG/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/tratamento farmacológico
5.
J Urol ; 206(3): 715-724, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33872051

RESUMO

PURPOSE: We present final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor therapy (Rezum™) for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 197 subjects >50 years of age with International Prostate Symptom Score ≥13, maximum flow rate ≤15 ml/second and prostate volume 30 to 80 cc were randomized and followed for 5 years. From the control arm of 61 subjects, a subset of 53 subjects requalified and after 3 months received treatment as part of the crossover group and were also followed for 5 years. The total number of vapor treatments to each lobe of the prostate was determined by length of prostatic urethra and included middle lobe treatment per physician discretion. RESULTS: Significant improvement of lower urinary tract symptoms was observed at <3 months post-thermal therapy, remaining durable through 5 years in the treatment group (International Prostate Symptom Score reduced 48%, quality of life increased 45%, maximum flow rate improved 44%, Benign Prostatic Hyperplasia Impact Index decreased 48%). Surgical re-treatment rate was 4.4% with no reports of device or procedure related sexual dysfunction or sustained de novo erectile dysfunction. Results within the crossover group were similar through 5 years. CONCLUSIONS: Minimally invasive treatment with water vapor thermal therapy provides significant and durable symptom relief as well as flow rate improvements through 5 years, with low surgical re-treatment rates and without impacting sexual function. It is a versatile therapy, providing successful treatment to obstructive lateral and middle lobes.


Assuntos
Hipertermia Induzida/métodos , Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Idoso , Estudos Cross-Over , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Seguimentos , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/estatística & dados numéricos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hiperplasia Prostática/complicações , Qualidade de Vida , Retratamento/estatística & dados numéricos , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Vapor , Estados Unidos
6.
Ann Surg Oncol ; 28(12): 7772-7782, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33839978

RESUMO

BACKGROUND: Coagulopathy after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recognized but few details have been studied. OBJECTIVES: The aim of this study was to investigate changes in coagulation biomarkers and their predictive ability for venous thromboembolism (VTE). METHODS: Patients undergoing CRS and HIPEC at Uppsala University Hospital, Sweden, from 2004 to 2014 were included in a prospective study of coagulation biomarkers. Prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, D-dimer, and platelets were sampled on postoperative days 1, 2, 5, and 10. Logistic regression analysis was used to evaluate predictive capacity for coagulation-related complications. RESULTS: Overall, 380 patients were included (214 females, mean age 56 years); 38 patients had a history of thromboembolism and 57 were active smokers. Mean perioperative blood loss was 1228 mL and 231 (61%) received perioperative blood transfusions. PT-INR and APTT were elevated directly after surgery but returned to normal levels on postoperative day 5. Conversely, fibrinogen, platelet count, D-dimer, and antithrombin increased by postoperative day 5 and continued to increase up to day 10. There were 23 radiologically verified cases of VTE within 6 months. The multivariate analysis identified a completeness of cytoreduction score of 2-3 (p = 0.047) and day 2 D-dimer (p = 0.0082) as independent risk factors for postoperative VTE. CONCLUSION: Significant postoperative changes in coagulation biomarkers occur with dynamic changes over 10 days postoperatively. The incidence of symptomatic VTE was low. Residual tumor at completion of surgery and elevated D-dimer on day 2 were independent risk factors for postoperative VTE.


Assuntos
Hipertermia Induzida , Tromboembolia Venosa , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica , Pessoa de Meia-Idade , Estudos Prospectivos , Tempo de Protrombina , Tromboembolia Venosa/etiologia
7.
Int J Cancer ; 149(2): 371-377, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-33687746

RESUMO

Malawi has the highest invasive cervical cancer (ICC) mortality rate worldwide, and ICC is the leading cause of cancer death among women. In 2004, Malawi adopted visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy. However, screening coverage has remained low (<30%) and few women (<50%) who require ablative treatment receive it. Additional barriers include long distances to health facilities and challenges with maintaining gas supplies. Thermal ablation is a safe and effective alternative to cryotherapy. We assessed the safety and uptake of community-based ICC screening with VIA and same-day treatment using a handheld thermocoagulator (HTU) in rural Malawi. We held educational talks alongside community leaders and conducted VIA screening in nonclinic community settings to nonpregnant women aged 25 to 49 years without history of hysterectomy or genital cancer/precancer. Eligible women received same-day thermal ablation and HIV testing/counseling. We collected cervical biopsies before treatment and followed up women at Weeks 6 and 12, with repeat biopsy at Week 12. Between July and August 2017, 408 (88%) of 463 eligible women underwent VIA. Overall, 7% (n = 30) of women had a positive VIA, of whom 93% (n = 28) underwent same-day thermal ablation. Among the 30 VIA-positive women, 5 had cervical intraepithelial neoplasia (CIN) 1, 4 had CIN 2/3 and 21 had benign histologic findings. Abnormal vaginal discharge (60%) and light vaginal bleeding (52%) were the most reported adverse events. There was high uptake of the community-based ICC screening in the study population and treatment was safe in this setting. Similar strategies that minimize false-positive results are urgently needed in Malawi.


Assuntos
Ácido Acético/administração & dosagem , Neoplasia Intraepitelial Cervical/terapia , Hipertermia Induzida/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Detecção Precoce de Câncer , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Malaui , Programas de Rastreamento , Pessoa de Meia-Idade , População Rural
8.
Eur J Cancer ; 147: 164-169, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33684876

RESUMO

A group of patients with adult-type soft tissue sarcoma is at high risk of local recurrence and distant metastases. Age, tumour site, histological subtype, tumour size and grade have been identified as the most important independent adverse prognostic factors. Macroscopically complete tumour resection is considered as the mainstay of treatment with the addition of preoperative or postoperative radiotherapy for extremity or trunk localisation. Retroperitoneal localisation requires compartmental resection and is associated with a worse prognosis. Here, radiotherapy is of no proven value. Perioperative chemotherapy is considered to treat micrometastatic disease not detectable at the time of diagnosis. The neoadjuvant application gives the risk of distant metastasis the greatest importance as therapy is carried out at the earliest possible time, whereas adjuvant chemotherapy is delayed by surgery and the necessary wound healing. With reported response rates up to 30%, both the operability may be improved and the risk of intraoperative tumour cell dissemination may be reduced, resulting also in reduced local relapse rates. However, the potential risk of early tumour progression may counteract this benefit. Optimised strategies with multimodality approaches including chemotherapy, regional hyperthermia (RHT) and immunotherapeutic agents have been shown to improve survival in high-risk patients. Here, we focus on the data from available randomised studies investigating the use of perioperative chemotherapy in patients with high-risk adult-type soft tissue sarcoma, including the use of RHT for local enhancement of chemotherapy effect and immune induction.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hipertermia Induzida , Terapia Neoadjuvante , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante , Ensaios Clínicos Fase III como Assunto , Progressão da Doença , Humanos , Hipertermia Induzida/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sarcoma/imunologia , Sarcoma/mortalidade , Sarcoma/patologia , Neoplasias de Tecidos Moles/imunologia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/patologia , Fatores de Tempo , Resultado do Tratamento
9.
Proc Inst Mech Eng H ; 235(5): 500-514, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33611979

RESUMO

The present study highlights an analytical hybrid scheme consisted of a shift of variables and finite integral transform for analysing a local thermal non-equilibrium (LTNE) bioheat model. This model can have utilised to be a betterment of prediction of the temperature field in the localised hyperthermia therapy (LHT) for the treatment of cancer patients. As the hyperthermia treatment is only the application in living tissues, an appropriate initial condition for the therapeutic thermal response is proposed instead of a constant temperature taken in the previous studies based on the 1-D heat flow. The present analysis suggests the therapeutic exposure time of 7776.8s (2.16 h) with constant heat flux and the exposure time of 10969.9s (3.06 h) with a sinusoidal heat flux within the usual temperature range of the hyperthermia (in a combination of thermal ablation and medium temperature hyperthermia) to be more effective in the treatment protocol. The presented results show that fatal injuries (tissue trauma, thermal burn, etc.) of internal organs might be possible to avoid by the current therapeutic condition. Therefore, this study may nullify the adverse effect of the existing model with the constant heating and consequently, the repercussion of the several therapeutic variables is to estimate with the development of a thermal profile for the suitability of a therapeutic condition. On the other hand, the present study well matches with the published analysis in case of both the theoretical and experimental (live tissues of the pig due to unavailability of real-time data on the human body) studies and it found the maximum deviation of the thermal response as 2.26% and 2.66%, respectively.


Assuntos
Queimaduras/prevenção & controle , Temperatura Alta/efeitos adversos , Temperatura Alta/uso terapêutico , Hipertermia Induzida/efeitos adversos , Neoplasias/terapia , Animais , Feminino , Humanos , Modelos Biológicos , Suínos
10.
Ann Palliat Med ; 10(1): 385-391, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33545771

RESUMO

BACKGROUND: Pleural effusion (PE) is one of the most common complications of advanced recurrent ovarian cancer. However, no studies have revealed the risk factors for PE after surgery. The purpose of this study is to observe the incidence and risk factors of PE after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with late-stage and recurrent ovarian cancer. METHODS: A retrospective analysis of 77 patients with late-stage and recurrent ovarian cancer after CRS + HIPEC was conducted. According to the presence of PE within 7 days after operation, two groups were formed. The basic information, surgical process, and laboratory examinations of the two groups were analyzed and compared to conduct a regression analysis. RESULTS: The incidence of postoperative PE was 57.1% (44/77 patients). Among these patients, the prevalence of grade I-II and grade III-IV PE was 42.8% (33/77 patients) and 14.3% (11/77 patients), respectively. There were statistically significant differences between the two groups in terms of preoperative PE, the duration of surgery, intraoperative blood loss, postoperative level of albumin, intestinal involvement, and diaphragmatic involvement. Among these, preoperative PE and diaphragmatic involvement were identified as independent risk factors of postoperative PE. CONCLUSIONS: Patients with late-stage and recurrent ovarian cancer invariably develop postoperative PE after CRS + HIPEC. Preoperative PE and diaphragmatic involvement are independent risk factors of postoperative PE. It is estimated that the incidence of postoperative PE among patients with these two independent risk factors is approximately 100%. Hence, we should promote the prevention and treatment of PE to improve its prognosis.


Assuntos
Hipertermia Induzida , Neoplasias Ovarianas , Neoplasias Peritoneais , Derrame Pleural , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Peritoneais/tratamento farmacológico , Derrame Pleural/etiologia , Estudos Retrospectivos , Fatores de Risco
11.
Ann Surg Oncol ; 28(8): 4499-4507, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33507449

RESUMO

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a major operation frequently necessitating red blood cell transfusion. Using multi-institutional data from the U.S. HIPEC Collaborative, this study sought to determine the association of perioperative allogenic blood transfusion (PABT) with perioperative outcomes after CRS/HIPEC. METHODS: This retrospective cohort study analyzed patients who underwent CRS/HIPEC for peritoneal surface malignancy between 2000 and 2017. Propensity score-matching was performed to mitigate bias. Univariate analysis was used to compare demographic, preoperative, intraoperative, and postoperative variables. Factors independently associated with PABT were identified using multivariate analysis. RESULTS: The inclusion criteria were met by 1717 patients, 510 (29.7%) of whom required PABT. The mean Peritoneal Cancer Index (PCI) of our cohort was 14.8 ± 9.3. Propensity score-matching showed an independent association between PABT and postoperative risk of pleural effusion, hemorrhage, pulmonary embolism, enteric fistula formation, Clavien-Dindo grades 3 and 4 morbidity, longer hospital stay, and reoperation (all P < 0.05 in the multivariate analysis). Compared with the patients who received 1 to 5 red blood cell (RBC) units, the patients who received more than 5 units had a greater risk of renal impairment, a longer intensive care unit (ICU) stay, and more postoperative infections. Finally, PABT was an independent predictor of worse survival for patients with appendiceal and colorectal primaries. CONCLUSION: Even low levels of PABT for patients undergoing CRS/HIPEC are independently associated with a greater risk of infectious and non-infectious postoperative complications, and this risk is increased for patients receiving more than 5 RBC units. Worse survival was independently predicted by PABT for patients with peritoneal carcinomatosis of an appendiceal or colorectal origin.


Assuntos
Neoplasias do Apêndice , Hipertermia Induzida , Neoplasias Peritoneais , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Apêndice/terapia , Transfusão de Sangue , Quimioterapia do Câncer por Perfusão Regional , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Neoplasias Peritoneais/tratamento farmacológico , Estudos Retrospectivos , Taxa de Sobrevida
12.
Ann Surg Oncol ; 28(9): 5287-5296, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33486643

RESUMO

BACKGROUND: Ninety-day hospital readmission rates following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) range from 20 to 40%. OBJECTIVE: The aim of this study was to develop and validate a simple score to predict readmissions following CRS/HIPEC. STUDY DESIGN: Using a prospectively maintained database, we retrospectively reviewed clinicopathologic, perioperative, and day-of-discharge data for patients undergoing CRS/HIPEC for peritoneal surface malignancies between 2010 and 2018. In-hospital mortalities and discharges to hospice were excluded. Multivariate logistic regression was utilized to identify predictors of unplanned readmission, with three-quarters of the sample randomly selected as the derivation cohort and one-quarter as the validation cohort. Using regression coefficient-based scoring methods, we developed a weighted 7-factor, 10-point predictive score for risk of readmission. RESULTS: Overall, 1068 eligible discharges were analyzed; 379 patients were readmitted within 90 days (35.5%). Seven factors were associated with readmission: stoma creation, Peritoneal Cancer Index score ≥ 15, hyponatremia, in-hospital major complication, preoperative chemotherapy, anemia, and discharge to nursing home. In the validation cohort, 25 patients (9.2%) were categorized as high risk for readmission, with a predicted rate of readmission of 69.3% and an observed rate of 76.0%. The score had fair discrimination (area under the curve 0.70) and good calibration (Hosmer-Lemeshow goodness-of-fit p-value of 0.77). CONCLUSION: Our proposed risk score, easily obtainable on day of discharge, distinguishes patients at high risk for readmission over 90 days following CRS/HIPEC. This score has the potential to target high-risk individuals for intensive follow-up and other interventions.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco
13.
Ultrasound Med Biol ; 47(4): 982-997, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33451816

RESUMO

Lyso-thermosensitive liposomes (LTSLs) are specifically designed to release chemotherapy agents under conditions of mild hyperthermia. Preclinical studies have indicated that magnetic resonance (MR)-guided focused ultrasound (FUS) systems can generate well-controlled volumetric hyperthermia using real-time thermometry. However, high-throughput clinical translation of these approaches for drug delivery is challenging, not least because of the significant cost overhead of MR guidance and the much larger volumes that need to be heated clinically. Using an ultrasound-guided extracorporeal clinical FUS device (Chongqing HAIFU, JC200) with thermistors in a non-perfused ex vivo bovine liver tissue model with ribs, we present an optimised strategy for rapidly inducing (5-15 min) and sustaining (>30 min) mild hyperthermia (ΔT <+4°C) in large tissue volumes (≤92 cm3). We describe successful clinical translation in a first-in-human clinical trial of targeted drug delivery of LTSLs (TARDOX: a phase I study to investigate drug release from thermosensitive liposomes in liver tumours), in which targeted tumour hyperthermia resulted in localised chemo-ablation. The heating strategy is potentially applicable to other indications and ultrasound-guided FUS devices.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antibióticos Antineoplásicos/administração & dosagem , Neoplasias Colorretais/patologia , Sistemas de Liberação de Medicamentos , Hipertermia Induzida/instrumentação , Neoplasias Hepáticas/tratamento farmacológico , Ultrassonografia/instrumentação , Adenocarcinoma/secundário , Animais , Bovinos , Análise Custo-Benefício , Sistemas de Liberação de Medicamentos/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/métodos , Lipossomos , Fígado , Neoplasias Hepáticas/secundário , Costelas , Temperatura , Ultrassonografia de Intervenção
14.
J Surg Oncol ; 123(4): 1045-1049, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33497472

RESUMO

INTRODUCTION: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this procedure on fertility are unknown. The aim of this study was to assess the current association of CRS/HIPEC with fertility following surgery. METHODS: A review of patients who underwent CRS/HIPEC between 2009 and 2018 was performed. Female patients were included if they were between ages 18-50 at the time of surgery. Gynecologic and obstetric history before and following CRS/HIPEC was collected by phone interview. RESULTS: Of 48 eligible participants, 21 completed the survey. Sixty-five percent of women underwent a total abdominal hysterectomy before or during CRS. Twenty-nine percent of these women recall fertility counseling before CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation before treatment. There were no pregnancies reported following treatment with CRS/HIPEC. CONCLUSION: Few patients after CRS/HIPEC retain child-bearing potential, partly due to the high rate of hysterectomy and oophorectomy at time of surgery. Efforts towards improved preoperative counseling, increased oocyte cryopreservation, and evaluating the safety of preserving reproductive organs at the time of surgery are needed.


Assuntos
Coeficiente de Natalidade/tendências , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Hipertermia Induzida/efeitos adversos , Neoplasias/terapia , Neoplasias Peritoneais/terapia , Adolescente , Adulto , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias Peritoneais/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
15.
Int J Nanomedicine ; 16: 75-88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33447028

RESUMO

Purpose: Current treatment options for muscle-invasive bladder cancer (MIBC) are associated with substantial morbidity. Local release of doxorubicin (DOX) from phosphatidyldiglycerol-based thermosensitive liposomes (DPPG2-TSL-DOX) potentiated by hyperthermia (HT) in the bladder wall may result in bladder sparing without toxicity of systemic chemotherapy. We investigated whether this approach, compared to conventional DOX application, increases DOX concentrations in the bladder wall while limiting DOX in essential organs. Materials and Methods: Twenty-one pigs were anaesthetized, and a urinary catheter equipped with a radiofrequency-emitting antenna for HT (60 minutes) was placed. Experimental groups consisted of iv low or full dose (20 or 60 mg/m2) DPPG2-TSL-DOX with/without HT, iv low dose (20 mg/m2) free DOX with HT, and full dose (50 mg/50 mL) intravesical DOX with/without HT. After the procedure, animals were immediately sacrificed. HPLC was used to measure DOX levels in the bladder, essential organs and serum, and fluorescence microscopy to evaluate DOX distribution in the bladder wall. Results: Iv DPPG2-TSL-DOX with HT resulted in a significantly higher bladder wall DOX concentration which was more homogeneous distributed, than iv and intravesical free DOX administration with HT. Specifically in the detrusor, DPPG2-TSL-DOX with HT led to a >7- and 44-fold higher DOX concentration, compared to iv free DOX with HT and intravesical DOX, respectively. Organ DOX concentrations were significantly lower in heart and kidneys, and similar in liver, spleen and lungs, following iv DPPG2-TSL-DOX with HT, compared to iv free DOX. Intravesical DOX led to the lowest organ DOX concentrations. Conclusion: Iv DPPG2-TSL-DOX combined with HT achieved higher DOX concentrations in the bladder wall including the detrusor, compared to conventional iv and intravesical DOX application. In combination with lower DOX accumulation in heart and kidneys, compared to iv free chemotherapy, DPPG2-TSL-DOX with HT has great potential to attain a role as a bladder-sparing treatment for MIBC.


Assuntos
Doxorrubicina/uso terapêutico , Hipertermia Induzida , Músculos/patologia , Fosfatidilgliceróis/química , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Animais , Antibióticos Antineoplásicos/administração & dosagem , Linhagem Celular Tumoral , Doxorrubicina/sangue , Doxorrubicina/farmacocinética , Doxorrubicina/farmacologia , Sistemas de Liberação de Medicamentos , Feminino , Fluorescência , Humanos , Hipertermia Induzida/efeitos adversos , Lipossomos , Invasividade Neoplásica , Suínos , Temperatura , Neoplasias da Bexiga Urinária/sangue
16.
Thorac Cardiovasc Surg ; 69(2): 157-164, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-31731316

RESUMO

BACKGROUND: Objective of this study was to assess postoperative morbidity and mortality as well as recurrence-free and overall survival in patients with thymic malignancies and pleural dissemination undergoing surgical cytoreduction and hyperthermic intrathoracic chemotherapy (HITOC). METHODS: Retrospective study between September 2008 and December 2017 with follow-up analysis in May 2018. RESULTS: A total of 29 patients (male: n = 17) with thymic malignancies and pleural spread (primary stage IVa: n = 11; pleural recurrence: n = 18) were included. Surgical cytoreduction was performed via pleurectomy/decortication (P/D; n = 11), extended P/D (n = 15), and extrapleural pneumonectomy (EPP; n = 3). These procedures resulted in 25 (86%) patients with macroscopically complete (R0/R1) resection. Intraoperative HITOC was performed for 60 minutes at 42°C either with cisplatin (100 mg/m2 body surface area [BSA] n = 8; 150 mg/m2 BSA n = 6; 175 mg/m2 BSA n = 1) or with a combination of cisplatin (175 mg/m2 BSA)/doxorubicin (65 mg; n = 14). Postoperative complications occurred in nine patients (31%). Cytoprotective therapy resulted in lower postoperative creatinine levels (p = 0.036), and there was no need for temporary dialysis in these patients. The 90-day mortality rate was 3.4%, as one patient developed multiple organ failure. While recurrence-free 5-year survival was 54%, an overall 5-year survival rate of 80.1% was observed. Survival depended on histological subtype (p = 0.01). CONCLUSION: Surgical cytoreduction with HITOC is feasible in selected patients and offers encouraging survival rates. The application of cytoprotective agents appears to be effective for the prevention of postoperative renal insufficiency.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Procedimentos Cirúrgicos de Citorredução , Doxorrubicina/uso terapêutico , Hipertermia Induzida , Neoplasias Pleurais/terapia , Neoplasias do Timo/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante , Cisplatino/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/mortalidade , Progressão da Doença , Doxorrubicina/efeitos adversos , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Fatores de Tempo , Resultado do Tratamento
17.
J Thorac Cardiovasc Surg ; 161(4): 1510-1518, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32631662

RESUMO

OBJECTIVES: Cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin has been used successfully to treat malignant pleural mesothelioma, a highly aggressive malignancy that is rapidly fatal in most cases. We hypothesized that the combination of ischemic injury with nephrotoxic injury from cisplatin would result in high rates of acute kidney injury. METHODS: We conducted an observational study in 503 patients to study the risks and outcomes of acute kidney injury after surgical resection of malignant pleural mesothelioma. Eligible subjects underwent extrapleural pneumonectomy or pleurectomy/decortication with or without hyperthermic intraoperative chemotherapy. Acute kidney injury was defined as an increase in creatinine of 26.5 µmol/L or greater within 48 hours of surgery or a 50% or greater increase over 7 days. RESULTS: Acute kidney injury developed in 243 patients (48.3%). Severe acute kidney injury requiring renal replacement therapy developed in 16 patients (3.2%). Major significant predictors for acute kidney injury included male sex (odds ratio, 2.98; P < .001), intraoperative cisplatin administration (odds ratio, 3.12; P < .001), previous cisplatin exposure (odds ratio, 1.96; P = .02), hypertension (odds ratio, 1.57; P = .02), and longer surgical time (odds ratio, 1.15 per hour; P = .02). Compared with patients without acute kidney injury, those with severe acute kidney injury had longer length of stay (26 vs 13 days) and a 2.71-fold increased risk of death in multivariable-adjusted models. CONCLUSIONS: Acute kidney injury is common after cytoreductive surgery with hyperthermic intraoperative chemotherapy with cisplatin and is associated with poor long-term outcomes. Strategies to prevent postoperative acute kidney injury are needed to improve multimodal treatment of malignant pleural mesothelioma.


Assuntos
Injúria Renal Aguda/epidemiologia , Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Mesotelioma Maligno/terapia , Neoplasias Pleurais/terapia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Idoso , Terapia Combinada , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Tempo de Internação , Masculino , Mesotelioma Maligno/mortalidade , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Neoplasias Pleurais/mortalidade , Pneumonectomia/efeitos adversos , Estudos Retrospectivos
18.
Ann Surg Oncol ; 28(1): 233-243, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32524458

RESUMO

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for peritoneal carcinomatosis. OBJECTIVE: The aim of this study was to determine the predictive value of postoperative inflammatory biomarkers in assessing complications after CRS and HIPEC. METHODS: A prospective database of 181 patients, who underwent CRS-HIPEC between March 2014 through April 2018 in the Erasmus MC, was retrospectively analyzed. Postoperative complications were defined according to the serious adverse event (SAE) grading system. Levels of C-reactive protein (CRP) and white blood cell (WBC) count were compared between patients with SAE grade < 3 and SAE grade ≥ 3. The area under the receiver operating characteristic curve (AUC) was calculated for CRP and WBC against SAE ≥ 3 and various intra-abdominal complications. RESULTS: SAE ≥ 3 postoperative complications occurred in 50 patients. From the second until the fifth postoperative day (POD), CRP levels were significantly higher (p = 0.023, p < 0.001, p = 0.002, and p = 0.002, respectively) in these patients. CRP concentrations above 166 mg/L on POD3 (AUC 0.75) and 116 mg/L on POD4 (AUC 0.70) were associated with the highest risk of an SAE ≥ 3. Postoperative WBC levels were not significantly different between patients with SAE < 3 and SAE ≥ 3 complications. CONCLUSION: Data from our hospital suggest that CRP levels that continue to rise after POD2 or that are ≥ 166 mg/L at POD3 or ≥ 116 mg/L at POD4, indicate a considerable risk for developing high-grade SAEs. The cut-off values we found can potentially be used as a threshold for additional diagnostic interventions, after they have been validated in external data.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Protocolos de Quimioterapia Combinada Antineoplásica , Proteína C-Reativa , Terapia Combinada , Estudos Transversais , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
19.
J Surg Res ; 259: 1-7, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33278792

RESUMO

PURPOSE: Ablative techniques have emerged as new potential therapeutic options for patients with locally advanced pancreatic cancer (LAPC). We explored the safety and feasibility of using TRANBERG|Thermal Therapy System (Clinical Laserthermia Systems AB, Lund, Sweden) in feedback mode for immunostimulating Interstitial Laser Thermotherapy (imILT) protocol, the newest ablative technique introduced for the treatment of LAPC. METHODS: The safety and feasibility results after the use of imILT protocol treatment in 15 patients of a prospective series of postsystemic therapy LAPC in two high-volume European institutions, the General and Pancreatic Unit of the Pancreas Institute, of the University of Verona, Italy, and the Department of Surgical Oncology of the Institut Paoli-Calmettes of Marseille, France, were assessed. RESULTS: The mean age was 66 ± 5 years, with a mean tumor size of 34.6 (±8) mm. The median number of cycles of pre-imILT chemotherapy was 6 (6-12). The procedure was performed in 13 of 15 (86.6%) cases; indeed, in two cases, the procedure was not performed; in one, the procedure was considered technically demanding; in the other, liver metastases were found intraoperatively. In all treated cases, the procedure was completed. Three late pancreatic fistulas developed over four overall adverse events (26.6%) and were attributed to imILT. Mortality was nil. A learning curve is necessary to interpret and manage the laser parameters. CONCLUSIONS: Safety, feasibility, and device handling outcomes of using TRANBERG|Thermal Therapy System with temperature probes in feedback mode and imILT protocol on LAPC were not satisfactory. The metastatic setting may be appropriate to evaluate the hypothetic abscopal effect.#NCT02702986 and #NCT02973217.


Assuntos
Hipertermia Induzida/efeitos adversos , Imunoterapia/efeitos adversos , Terapia a Laser/efeitos adversos , Fístula Pancreática/epidemiologia , Neoplasias Pancreáticas/terapia , Idoso , Ensaios Clínicos Fase II como Assunto , Estudos de Viabilidade , Feminino , França , Humanos , Hipertermia Induzida/instrumentação , Hipertermia Induzida/métodos , Imunoterapia/instrumentação , Imunoterapia/métodos , Itália , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Pâncreas/imunologia , Pâncreas/patologia , Pâncreas/efeitos da radiação , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Fístula Pancreática/patologia , Neoplasias Pancreáticas/imunologia , Neoplasias Pancreáticas/patologia , Estudos Prospectivos , Resultado do Tratamento
20.
Surg Oncol ; 36: 115-119, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341606

RESUMO

PURPOSE: The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC). METHODS: This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey. RESULTS: A total of 64 patients were included in the study, with a median age of 55 years (range 28-78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence. DISCUSSION: Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.


Assuntos
Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Incontinência Fecal/patologia , Hipertermia Induzida/efeitos adversos , Neoplasias Ovarianas/terapia , Qualidade de Vida , Incontinência Urinária de Urgência/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Terapia Combinada , Estudos Transversais , Incontinência Fecal/etiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Prognóstico , Incontinência Urinária de Urgência/etiologia
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