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1.
Am J Case Rep ; 22: e927761, 2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33452231

RESUMO

BACKGROUND Neurofibromatosis type 1 (NF1) is a multi-tumor syndrome in which affected patients develop malignancies that are rare in the overall population, such as tumors of neural or endocrine origin. CASE REPORT A 67-year-old woman with a clinical diagnosis of NF1 presented with abdominal pain and pneumoperitoneum. She underwent small-bowel resections for a perforated jejunal lesion and a second lesion in the ileum; pathology showed a neurofibroma at the site of the perforation and a 1-cm low-grade GIST, respectively. Additional staging with cross-sectional imaging identified a 3.7-cm pancreatic head mass and a 1.7-cm left adrenal mass; biochemical studies revealed elevated serum gastrin and urinary free metanephrines and catecholamines consistent with pheochromocytoma. Initial surgical management was a left posterior retroperitoneoscopic adrenalectomy. Postoperatively, gallium-68-DOTATOC PET/CT showed uptake in the pancreatic head and a 28-mm left thyroid nodule. Months later, she had an open pancreaticoduodenectomy. Pathology showed pheochromocytoma and a low-grade (G1) gastrinoma involving 2/8 peripancreatic lymph nodes (pT3pN1M0), respectively. Fine-needle aspiration biopsy of the thyroid nodule showed features consistent with a Hürthle cell neoplasm. Genetic testing identified a pathogenic mutation in NF1 and no mutations in BRCA1/2, CDC72, MEN1, or PALB2. The patient continues surveillance, with no evidence of recurrent disease. CONCLUSIONS We report the fifth case of gastrinoma associated with NF1 and the first to arise from the pancreas. This case of a pancreatic neuroendocrine tumor was associated with multiple additional neoplasms. Neuroendocrine tumors found in NF1 should raise suspicion of other malignancies.


Assuntos
Adenoma Oxífilo/patologia , Neoplasias das Glândulas Endócrinas/patologia , Gastrinoma/patologia , Tumores do Estroma Gastrointestinal/patologia , Neurofibromatose 1/patologia , Feocromocitoma/patologia , Adenoma Oxífilo/terapia , Idoso , Neoplasias das Glândulas Endócrinas/terapia , Feminino , Gastrinoma/terapia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/terapia , Feocromocitoma/terapia
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(2): 122-127, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33508917

RESUMO

Gastrointestinal cancer and related treatments (surgery and chemoradiotherapy) are associated with declined functional status (FS) that has impact on quality of life, clinical outcome and continuum of care. Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care. Cancer patients often experience anxiety, depression, low self-esteem and fears of recurrence and death. Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment, which includes psychological, physical and nutritional assessments for a baseline functional level, identification of comorbidity, and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer, chemoradiotherapy and surgery. Multimodal prehabilitation program encompasses a series of planned, structured, repeatable and purposive interventions including comprehensive physical exercise, nutritional therapy, and relieving anxiety and depression, which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline, to cope with surgical stress and to improve the consequences. However, a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery, which consists of the optimal makeup of training programs, the timing and approach of the intervention, how to improve compliance, how to measure functional capacity, and how to make cost-effective analysis. Therefore, more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.


Assuntos
Neoplasias Gastrointestinais , Cuidados Pré-Operatórios , Qualidade de Vida , Quimiorradioterapia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/psicologia , Neoplasias Gastrointestinais/psicologia , Neoplasias Gastrointestinais/reabilitação , Neoplasias Gastrointestinais/terapia , Humanos , Recuperação de Função Fisiológica
3.
Eur J Cancer ; 144: 200-214, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33370645

RESUMO

Neuroendocrine neoplasms (NENs) are a heterogeneous family of uncommon tumours with challenging diagnosis, clinical management and unique needs that almost always requires a multidisciplinary approach. In the absence of guidance from the scientific literature, along with the rapidly changing data available on the effect of COVID-19, we report how 12 high-volume NEN centres of expertise in 10 countries at different stages of the evolving COVID-19 global pandemic along with members of international neuroendocrine cancer patient societies have suggested to preserve high standards of care for patients with NENs. We review the multidisciplinary management of neuroendocrine neoplasms during the COVID-19 pandemic, and we suggest potential strategies to reduce risk and aid multidisciplinary treatment decision-making. By sharing our joint experiences, we aim to generate recommendations for proceeding to other institutions facing the same challenges.


Assuntos
Tumor Carcinoide/terapia , Neoplasias Gastrointestinais/terapia , Oncologia/normas , Neoplasias Pancreáticas/terapia , Neoplasias Torácicas/terapia , Tumor Carcinoide/diagnóstico , Consenso , Neoplasias Gastrointestinais/diagnóstico , Humanos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Torácicas/diagnóstico
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 823-834, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927504

RESUMO

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. The successful application of molecular targeted agents has promoted the clinical diagnosis and treatment of GIST into the era of precision medicine. There are some pitfalls in the diagnosis (including preoperative diagnosis and pathological diagnosis), surgical treatment (including surgical procedure, minimally invasive surgery, and surgery for recurrent/metastatic GIST) and drug treatment (including duration of adjuvant therapy for very high risk GIST and timing of intervention during preoperative treatment) of GIST. In addition to difficulties of doctors, these pitfalls can also lead to waste of medical resources, and even endanger the health and life of patients. Each doctor engaged in the diagnosis and treatment of GIST needs to fully understand the biological characteristics and disease development pattern of GIST, and accurately recognize every possible trap in the clinical management. This paper analyzes the pitfalls and misunderstandings in various aspects of GIST diagnosis and treatment in order to provide clues for promoting more reasonable clinical decision-making.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Tomada de Decisão Clínica , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 835-839, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927505

RESUMO

The actual incidence of small gastrointestinal stromal tumors (GIST) increases gradually. Although the biological behavior of most of small GIST is benign or indolent, a few small GIST can develope to recurrence and metastasis with biological invasive behavior. Identification of biological behavior and malignant potential is the cornerstone of treatment. For non-gastric small GIST, surgery is always the treatment of choice. Regarding gastric small GIST, close follow-up is acceptable for patients without risk factors detected by endoscopic ultrasonography. Surgery should be suggested for those with high risks, or significant growth of tumor during follow-up. Complete resection with function preservation is the principle of surgery. Besides, individualized treatment should also be taken into consideration.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 852-857, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927508

RESUMO

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the digestive tract. Although GIST has only been recognized as a separate entity for several decades, management strategies for GIST have changed dramatically over time. Advances in treatment have yielded dramatic successes in improving prognosis of patients with GIST. However, the meaningful progress also brings escalating social and economic burdens. There is a long distance between technological breakthroughs and its real benefits of society. Due to the rapid development in a short period, successful experience in disease diagnosis and treatment and the accompanying problems have appeared in a more concentrated and obvious manner. Any medical science exploration and practice initially aim to have the essence of humanism. As practitioners of medical technology, doctors should treat patients as a whole "human" in the process of diagnosis and treatment instead of just focusing on the technology itself. Moreover, doctors should comprehensively consider patients' physical, psychological and social attributes, pay attention to their physical, mental and social needs, find and try to solve problems, so as to promote the developement of medical science in the correct direction.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Saúde Holística , Humanos , Invenções , Assistência ao Paciente/métodos , Prognóstico
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 866-871, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927511

RESUMO

The diagnosis and treatment of gastrointestinal stromal tumor (GIST) is getting more and more standardized. In the last two decades, due to the elucidation of molecular mechanism of tumorigenesis, as well as the effectiveness of tyrosine kinase inhibitors, GIST has become well-known as one of the most classical models of targeted therapy on solid tumors in the precision medicine era. The National Comprehensive Cancer Network (NCCN) issued the latest version of clinical practice guideline on soft tissue sarcoma in February 2020. Compared with previous versions, the new version of the guideline highlighted the treatment recommendations of avapritinib, which further promoted the precise targeted treatment of GIST.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Guias de Prática Clínica como Assunto/normas , Antineoplásicos/uso terapêutico , Humanos , Terapia de Alvo Molecular , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis/uso terapêutico , Pirróis/uso terapêutico , Triazinas/uso terapêutico
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 872-879, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927512

RESUMO

Objective: Platelet-derived growth factor alpha (PDGFRA) mutations are respectively rare in gastrointestinal stromal tumors (GIST). Most GIST with PDGFRA exon 18 mutations including D842V mutation are highly resistant to imatinib. The treatment of GIST harboring PDGFRA primary drug-resistant mutation is a major challenge. This article aims to investigate clinicopathologic features of GIST with PDGFRA-D842V mutation and the efficacy of comprehensive treatment, providing a reference for clinical practice. Methods: A retrospective cohort study was conducted to collect the clinicopathological and follow-up data of patients with GIST harboring PDGFRA mutation who were diagnosed and treated in the GIST Clinic of Renji Hospital from January 2005 to May 2020. According to the mutation site, the enrolled patients were divided into D842V mutation group and non-D842V mutation group. The differences of clinicopathologic characteristics between the two groups were compared. Furthermore, overall survival and prognostic factors were analyzed. Results: A total of 71 patients with PDGFRA-mutant GIST were included in this study, including 47 cases of D842V mutation (66.2%) and 24 cases of non-D842V mutation (33.8%). There were 28 male patients and 19 female patients in D842V mutation group, with a median age of 60 (36-82) years. There were 16 male patients and 8 female patients in non-D842V mutation group, with a median age of 62 (30-81) years. There were no significant differences in age, gender, primary location, surgical procedure, tumor size, mitotic count, expression of CD117 and DOG1, Ki-67 proliferation index and modified NIH grade between the two groups (all P>0.05). The positive rate of CD34 was 89.4% (42/47) and 62.5% (15/24) in the D842V mutation group and the non-D842V mutation group, respectively, with a statistically significant difference (χ(2)=5.644, P=0.018). Among all the cases, 66 cases underwent R0 resection without preoperative treatment; two cases underwent emergency operation with R1 resection because of tumor rupture; 2 cases were not operated after the pathological and mutation types were confirmed by biopsy (one case received avapritinib treatment and obtain partial remission). One case was diagnosed as wild-type GIST per needle biopsy in another institute, and underwent R0 resection after preoperative imatinib treatment for 6 months. After surgery, 5 high-risk GIST patients with D842V mutation and 5 high-risk GIST patients with non-D842V mutation were treated with imatinib for more than one year. The median follow-up time was 37 (1-153) months. As of the last follow-up among the patients who received R0 resection, 4 patients with D842V mutation had relapse, of whom 1 was in the period of imatinib administration, and the 3-year relapse-free survival rate was 94.2%; none of the patients with non-D842V mutation had relapse. There was no statistically significant difference in relapse-free surivval between two groups (P=0.233). Univariate analysis revealed that mitotic count (P=0.002), Ki-67 proliferation index (P<0.001) and modified NIH grade (P=0.025) were the factors associated with relapse-free survival of patients with D842V mutation after R0 resection (all P<0.05). However, the above factros were not testified as independant prognostic facors in multivariate Cox analysis (all P<0.05). Conclusion: Clinicopathologic features and the efficacy of radical resection in patients with PDGFRA-D842V mutation are similar to those in patients with non-D842V mutation.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/genética , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/genética , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Resistencia a Medicamentos Antineoplásicos/genética , Éxons , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Estudos Retrospectivos
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 896-903, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927515

RESUMO

Objective: At present, the modified NIH classification commonly used in clinical practice is still insufficient for assessing the risk of postoperative recurrence in some patients with intermediate-high risk gastrointestinal stromal tumors (GIST). Through exploring risk factors for recurrence of intermediate-high risk GIST, this study establishes a predictive model for recurrence with more convenience and more precision in order to guide adjuvant therapy for intermediate-high risk GIST patients. Methods: A retrospective case-control study was carried out. Clinical and pathological data of 432 GIST patients who did not receive preoperative targeted treatment, underwent complete resection in the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2005 to June 2018, and were diagnosed as intermediate- or high-risk based on modified NIH classification by postopertive pathology, were retrospectively analyzed. Cox regression model was used to idenitify independent risk factors of recurrence, and a recurrence risk scoring model was established. The receiver operating characteristic curve (ROC curve), consistency index (C-index) and calibration curve were used to evaluate the accuracy of the scoring model in predicting the recurrence of moderate-risk and high-risk GIST patients. Results: Among 432 GIST patients, 332 were diagnosed as high-risk and 100 as moderate-risk; 237 were males and 195 females with average age of (57.4±12.4) years. Of 432 patients, 211 cases (48.8%) had fibrinogen (FIB) >3.5 g/L; 85 cases (19.7%) had platelet to lymphocyte ratio (PLR)>272.5; 122 cases (28.2%) had neutrophil to lymphocyte ratio (NLR) > 4.2; 102 cases (23.6%) had systemic inflammatory reaction index (SIRI)> 2.7; 198 cases (45.8%) had tumor long diameter >8 cm and 108 cases (25.0%) had mitotic counts > 8/50 HPF. Cox multivariable analysis showed that FIB (HR=1.789, 95% CI: 1.058-3.027, P=0.030), PLR (HR=1.862, 95% CI: 1.067-3.249, P=0.029), SIRI (HR=1.790, 95% CI: 1.039-3.084, P=0.036), tumor long diameter (HR=1.970, 95% CI: 1.105-2.925, P=0.017) and mitotic counts (HR=2.187, 95% CI:1.211-3.950, P=0.009) were independent risk factors for recurrence in patients with middle-risk and high-risk GIST. These 5 factors were included in the risk scoring model, which was given a weight score of 58 points, 62 points, 58 points, 63 points, and 78 points, respectively. Patients with a total score of ≤ 78 points were classified as moderate-risk recurrence (group I), those of 78 to 136 points as high-risk recurrence (group II) and those of >136 points as very high-risk recurrence (group III). ROC curve showed that the area under the curve (AUC) of the scoring model was 0.730 and the C-index was 0.724 (95% CI:0.687-0.787). The calibration curves and the Kaplan-Meier curves of patients in the three groups revealed that this model had a good predictive accuracy. Conclusions: For intermediate-risk and high-risk GIST patients, the preoperative FIB >3.5 g/L, PLR > 272.5 and SIRI > 2.7 are independent risk factors of recurrence after surgery. The recurrence risk scoring model established by combining tumor long diameter, mitotic counts, FIB, PLR and SIRI can effectively predict the risk of postoperative recurrence and metastasis in moderate-risk and high-risk GIST patients.


Assuntos
Fibrinogênio/análise , Neoplasias Gastrointestinais/sangue , Tumores do Estroma Gastrointestinal/sangue , Inflamação/sangue , Recidiva Local de Neoplasia/sangue , Idoso , Estudos de Casos e Controles , Terapia Combinada , Feminino , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Inflamação/diagnóstico , Inflamação/patologia , Inflamação/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
11.
Am J Clin Oncol ; 43(9): 636-639, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889833

RESUMO

OBJECTIVES: Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC. MATERIALS AND METHODS: Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. RESULTS: The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users. CONCLUSIONS: MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.


Assuntos
Maconha Medicinal/uso terapêutico , Neoplasias/complicações , Neoplasias/terapia , Fitoterapia , Preparações de Plantas/uso terapêutico , Adolescente , Adulto , Idoso , Anorexia/tratamento farmacológico , Anorexia/etiologia , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Dor do Câncer/tratamento farmacológico , Cannabis , Feminino , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/terapia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Maconha Medicinal/efeitos adversos , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Preparações de Plantas/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Inquéritos e Questionários , Adulto Jovem
13.
Nat Rev Endocrinol ; 16(10): 590-607, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32839579

RESUMO

Over the past 5 years, a number of notable research advances have been made in the field of neuroendocrine cancer, specifically with regard to neuroendocrine cancer of the gastrointestinal tract. The aim of this Review is to provide an update on current knowledge that has proven effective for the clinical management of patients with these tumours. For example, for the first time in the tubular gastrointestinal tract, well-differentiated high-grade (grade 3) tumours and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are defined in the WHO classification. This novel classification enables efficient identification of the most aggressive well-differentiated neuroendocrine tumours and helps in defining the degree of aggressiveness of MiNENs. The Review also discusses updates to epidemiology, cell biology (including vesicle-specific components) and the as-yet-unresolved complex genetic background that varies according to site and differentiation status. The Review summarizes novel diagnostic instruments, including molecules associated with the secretory machinery, novel radiological approaches (including pattern recognition techniques), novel PET tracers and liquid biopsy combined with DNA or RNA assays. Surgery remains the treatment mainstay; however, peptide receptor radionuclide therapy with novel radioligands and new emerging medical therapies (including vaccination and immunotherapy) are evolving and being tested in clinical trials, which are summarized and critically reviewed here.


Assuntos
Neoplasias Gastrointestinais , Tumores Neuroendócrinos , Medicina de Precisão , Animais , Antineoplásicos/uso terapêutico , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/fisiopatologia , Neoplasias Gastrointestinais/secundário , Neoplasias Gastrointestinais/terapia , Humanos , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/fisiopatologia , Tumores Neuroendócrinos/terapia , Organização Mundial da Saúde
16.
JCO Glob Oncol ; 6: 1046-1051, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639877

RESUMO

PURPOSE: Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic. METHODS: Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences. RESULTS: Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time. CONCLUSION: Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.


Assuntos
Assistência Ambulatorial/métodos , Infecções por Coronavirus/epidemiologia , Oncologia/métodos , Pandemias , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Sarcoma/terapia , Telemedicina/métodos , Carga de Trabalho , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Assistência à Saúde/métodos , Feminino , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias de Tecidos Moles/terapia , Viagem , Reino Unido/epidemiologia , Adulto Jovem
17.
Dig Liver Dis ; 52(11): 1346-1350, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32601037

RESUMO

After the lockdown during the emergency phase of the Covid-19 pandemic, we have to deal with phase 2, a period of uncertain duration, with a controlled and progressive return to normalization, in which we need to reconcile our work and our movements with the presence of the virus on our territory. Digestive endoscopic activity is a high-risk transmission procedure for Covid-19. The measures put in place to protect healthcare personnel and patients are stressful and "time-consuming" and lead to a reduction in the number of endoscopic procedures that can be performed. In this scenario, the Oncological Institutes are forced to make a rigorous selection of patients to undergo endoscopic examinations and treatments, according to lists of exceptional priorities, in order to guarantee cancer patients and subjects at high risk of developing digestive tumors, a preferential diagnostic and therapeutic process, protected from contagion risks. For this purpose, cuts and postponing times of endoscopic performances are here proposed, which go beyond the guidelines of scientific societies and have little evidences in the literature. These changes should be applied limited to this exceptional period and in proportion to the capacity of each operating unit in order to meet the demands of the patients.


Assuntos
Institutos de Câncer/organização & administração , Endoscopia Gastrointestinal , Seleção de Pacientes , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/transmissão , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Humanos , Pandemias , Pneumonia Viral/transmissão
18.
Cancer Immunol Immunother ; 69(11): 2393-2401, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32535637

RESUMO

BACKGROUND: The majority of patients with advanced gastrointestinal stromal tumor (GIST) develop resistance to imatinib, and subsequent treatments have limited efficacy. Ilixadencel (allogeneic inflammatory dendritic cells) is a cell-based immune primer injected intratumorally that previously has been clinically investigated in metastatic renal cell carcinoma and hepatocellular carcinoma. METHODS: The trial was a single arm phase I trial assessing safety and efficacy of ilixadencel in subjects with progressing advanced/metastatic GIST despite ongoing treatment with second or later lines of tyrosine kinase inhibitors (TKI). Three patients were progressing while on sunitinib (second line), one on regorafenib (third line), and two on pazopanib (fourth line). TKI treatment was maintained throughout, while two intratumoral injections of ilixadencel (10 × 106 viable and HLA-DR expressing cells per dose) were administered. RESULTS: No severe adverse events were found to be related to ilixadencel administration. Four patients showed continued tumor progression at 3 months per RECIST 1.1 and Choi criteria. One patient (on third line regorafenib) had stable disease for 9 months and another patient (on second line sunitinib) had stable disease at end of study (12 months) as per RECIST 1.1. These two patients developed a partial response as per Choi criteria with a duration of 3 and 6 months, respectively. The median progression-free survival (PFS) was 4.0 months. CONCLUSION: Ilixadencel treatment presented an acceptable safety profile among advanced GIST patients who developed resistance to TKI. Encouraging radiological tumor responses were detected in 33% of treated patients, supporting further investigation. Clinical trial registration www.clinicaltrials.gov ; NCT: 02432846; registration date: February 22, 2016.


Assuntos
Antineoplásicos/uso terapêutico , Células Dendríticas/transplante , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/terapia , Idoso , Idoso de 80 Anos ou mais , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Homólogo
19.
Z Gastroenterol ; 58(6): 564-576, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32544966

RESUMO

Older patients (65 years and over) represent the majority of patients with a cancer diagnosis. For oesophageal carcinomas, the age peak is in the seventh to eighth decade of life. In gastric carcinoma, 1/3 of patients are older than 75 years and approximately 45 % of colon carcinoma patients are ≥ 75 years old.Due to existing comorbidities, age-related changes and polypharmacy, older patients present a special challenge in tumor therapy.In studies, these patients are usually clearly under-represented and "elderly"-studies are rare.New surgical procedures with laparoscopy and also robotic provide advantages for esophageal and gastric carcinoma, which in the future can reduce postoperative morbidity in relation to cardiac and pulmonary complications for old and older patients. The selection of suitable patients is essential here.With regard to chemotherapy, fluoropyrimidines and oxaliplatin are well tolerated; triplet therapies should be avoided. Immunotherapy in particular offers an interesting alternative to standard chemotherapy due to its better side effect profile.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias do Colo/terapia , Neoplasias Esofágicas/terapia , Neoplasias Gastrointestinais/terapia , Imunoterapia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/terapia , Procedimentos Cirúrgicos Operatórios , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Neoplasias Esofágicas/patologia , Neoplasias Gastrointestinais/patologia , Humanos , Oxaliplatina/uso terapêutico , Neoplasias Gástricas/patologia
20.
Int J Hematol ; 112(3): 385-394, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32519171

RESUMO

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma often with extranodal involvement at diagnosis, and yet how this feature correlates with survival awaits elucidation. To address this issue, a correlative analysis between clinical features of 127 MCL patients and their overall survival (OS) was conducted. In this cohort, the median age at MCL diagnosis was 62 years and 81% were males. Eighty-four percent of patients were Ann Arbor stage 4, and 15% were blastoid variants. In patients with gastrointestinal MCL, approximately 40% had gastric involvement. In treatment, CHOP-based induction chemotherapy was given to 61.1% of patients. One-third of patients undertook autologous stem cell transplant (SCT), and 4.7% had allogeneic SCT. The median OS was 82 months and well-stratified in MIPI risk groups. In the multivariate analysis for OS, blastoid variants and gastric involvement were both independent risk factors whereas auto-SCT had a protective effect. Overall, this study corroborated with the current understandings and international therapeutic standards for MCL. Auto-SCT associated with a better OS while allo-SCT remained an option for blastoid variants and those who failed Auto-SCT. Interestingly, patients with gastric involvement tended to have worse survival, a finding that spawns more studies to investigate the mechanism.


Assuntos
Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/terapia , Linfoma de Célula do Manto/mortalidade , Linfoma de Célula do Manto/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos de Coortes , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prognóstico , Indução de Remissão , Transplante de Células-Tronco , Taiwan/epidemiologia , Transplante Autólogo , Transplante Homólogo , Vincristina/administração & dosagem
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