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1.
Medicine (Baltimore) ; 99(41): e22647, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031325

RESUMO

RATIONALE: Signet ring cell carcinoma of the stomach is prone to relapse and metastasis after traditional surgical treatment, and the prognosis is also poor. We improved the concept of treatment and conducted cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) combined with intraperitoneal (IP) and intravenous (IV) chemotherapy for a gastric signet-cell carcinoma patient. PATIENT CONCERNS: A 65-year-old male patient with complaint of intermittent hematemesis for over 10 days was referred to our hospital for treatment. The patient developed hematemesis of 800 mL without obvious causes on May 27, 2015, accompanied by dizziness and amaurosis fugax. After the bleeding was stopped with medicinal treatment, diagnostic gastroscopy revealed an ulcer at the less curvature of the stomach, with biopsy pathology diagnosis as severe atypical hyperplasia, which was confirmed to be poorly differentiated adenocarcinoma by a second biopsy. In past medical history, the patient had 5 coronary stents implanted because of coronary atherosclerotic heart disease 3 years ago. DIAGNOSIS: Gastric cancer (cT4NxMx) according to the patient's history and biopsy pathology. INTERVENTIONS: the patient was treated surgery-based multidisciplinary treatments integrating CRS + HIPEC and IP + IV adjuvant chemotherapy. The CRS was curative distal gastrectomy with D2 lymphadenectomy, and HIPEC was cisplatin 120 mg plus mitomycin C 30 mg at 43 °C, for 60 minutes. Final pathological diagnosis of after surgery was: poorly differentiate adenocarcinoma with signet-ring cells, with invasion beyond the serosal layer and into the duodenum, 10/23 lymph nodes positive, nerve invasion, vascular tumor thrombi, Borrmann type IV, Lauren type diffuse. TNM stage was pT4aN3M0, IIIC. After operation, the patient received 6 courses of IV chemotherapy with oxaliplatin and 5-fluorouracil/Tegafur Gimeracil Oteracil Potassium capsules, and IP chemotherapy with docetaxel and carboplatin. OUTCOMES: Regular follow-up till July 20, 2020, revealed that the patient has a disease-free survival of over 61+ months. LESSONS: CRS + HIPEC combined with IP + IV chemotherapy achieved long-term disease-free survival for this patient with gastric signet-ring cell carcinoma and deserve further study. This new treatment modality deserves appropriate consideration in routine clinical practice for patients with advanced gastric cancer.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma de Células em Anel de Sinete/cirurgia , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Neoplasias Gástricas/cirurgia , Idoso , Carcinoma de Células em Anel de Sinete/tratamento farmacológico , Terapia Combinada , Humanos , Masculino , Neoplasias Gástricas/tratamento farmacológico
2.
Yonsei Med J ; 61(11): 935-941, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107236

RESUMO

PURPOSE: Salvage second-line chemotherapy is usually recommended for patients with advanced epithelial ovarian cancer (AEOC) who develop progressive disease (PD) after neoadjuvant chemotherapy (NAC). Herein, we investigated the role of cytoreductive surgery (CRS) for such patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 36 patients with AEOC who developed PD after receiving NAC at two tertiary academic centers with different treatment strategies between 2001 and 2016. Patients who developed PD after NAC were consistently treated with CRS at one hospital (group A; n=13) and second-line chemotherapy at another (group B; n=23). The clinical characteristics and treatment outcomes were compared between the groups. RESULTS: Overall survival (OS) was longer in group A than in group B (19.4 months vs. 7.9 months; p=0.011). High-grade serous histology was associated with longer OS than non-high-grade serous types. In group A, optimal surgery resection (<1 cm) was achieved after CRS in 6 patients (46%). Multivariate analysis showed that the treatment option was the only independent predictive factor for OS (hazard ratio, 2.30; 95% confidence interval, 1.02-5.17; p=0.044). CONCLUSION: CRS may result in a survival benefit even in patients with AEOC who develop PD after NAC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Neoplasias Ovarianas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Epitelial do Ovário/mortalidade , Carcinoma Epitelial do Ovário/patologia , Procedimentos Cirúrgicos de Citorredução/mortalidade , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Terapia Neoadjuvante/mortalidade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 840-844, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927506

RESUMO

In patients with recurrent or metastatic gastrointestinal stromal tumor (GIST), imatinib is the mainstay treatment, which has significantly improved outcome. However, approximately half of patients who have initial respose to imatinib will develop secondary resistance within 2 years, leading to progressive disease. Available data suggest that cytoreductive surgery may be considered in patients with metastatic GIST who respond to imatinib and have relatively low tumor burden, particularly in whom a R0/R1 resection is anticipated. The evidence of benefit from surgery in patients with focal tumor progression on imatinib is limited, but after surgical resection of progressive lesions, shifting to second line therapy should be initiated. Patients with multifocal progression are not suitable for surgical intervention. In the meantime, surgery for patients treated with sunitinib is feasible, yet survival benefit remains controversial. Thus, surgery should be considered in patients with metastatic GIST whose disease responds to imatinib with a goal of performing R0/R1 resection. On a case-by-case basis, surgical intervention should be determined after careful multidisciplinary consultation to achieve safety, improvement of symptoms and long-term survival benefits.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Mesilato de Imatinib/uso terapêutico , Recidiva Local de Neoplasia/cirurgia , Procedimentos Cirúrgicos de Citorredução , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/secundário , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Equipe de Assistência ao Paciente , Sunitinibe/uso terapêutico , Resultado do Tratamento , Carga Tumoral
5.
Unfallchirurg ; 123(10): 783-791, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32936323

RESUMO

Nowadays, although minimally invasive procedures are the standard for the treatment of thoracolumbar spinal injuries, these techniques are not yet established for the cervical spine. This is due to anatomical and technical reasons and also due to the fact that the classical anterior decompression and fusion procedure already fulfils the criteria of minimally invasiveness and is suitable for the vast majority of injuries. The existing literature consists mainly of case reports and small comparative cohort studies, the results of which are presented. There is a minimally invasive variant for nearly all open procedures, mainly in the upper cervical spine but also in the lower cervical spine. The further development of these promising techniques is still pending.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral , Traumatismos da Coluna Vertebral , Procedimentos Cirúrgicos de Citorredução , Humanos , Vértebras Lombares , Vértebras Torácicas
6.
Medicine (Baltimore) ; 99(33): e21546, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872001

RESUMO

INTRODUCTION: The efficacy of different timings of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in controlling malignant ascites caused by peritoneal carcinomatosis of colorectal cancer (CRC) is not well defined. The study aims to investigate the clinical efficacy and safety of different timings of CRS with HIPEC for malignant ascites caused by peritoneal carcinomatosis from CRC. MATERIALS AND METHODS: This was a preliminary randomized controlled study performed at the Intracelom Hyperthermic Perfusion Therapy Center of the Cancer Hospital of Guangzhou Medical University (China) from December 2008 to December 2016. The patients were randomized to: CRS, followed by HIPEC (CRS+HIPEC; n = 14), and ultrasound-guided HIPEC, followed by CRS 1 to 2 weeks later (HIPEC+ delayed cytoreductive surgery (dCRS) group, n = 14). The endpoints were complete remission rate of ascites, successful complete CRS rate, and overall survival. RESULTS: Malignant ascites in all patients showed complete remission; the total effective rate was 100%. Complete CRS was not feasible in any patient. The median follow-up of the 2 groups was 41.9 and 42.3 months in the CRS+HIPEC and HIPEC+dCRS groups, respectively. Overall survival was 14.5 (95%CI: 7-19 months) and 14.3 months (95%CI: 4-21 months) (P > .05). The adverse effects of HIPEC were manageable. CONCLUSIONS: CRS+HIPEC and HIPEC+dCRS have the same efficacy in controlling malignant ascites caused by CRC and peritoneal carcinomatosis. The timing of CRS and HIPEC does not prolong the survival of patients with peritoneal carcinomatosis from CRC, even when a complete CRS is not feasible.


Assuntos
Ascite/etiologia , Ascite/terapia , Neoplasias Colorretais/complicações , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Adulto , Idoso , Ascite/mortalidade , China , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Ultrassonografia de Intervenção
7.
Anticancer Res ; 40(10): 5869-5875, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988917

RESUMO

BACKGROUND/AIM: We aimed to identify differences in cytoreduction rates and procedures performed in patients with advanced ovarian cancer undergoing primary (PDS) or interval debulking surgery (IDS). PATIENTS AND METHODS: Data were collected prospectively on 110 consecutive patients from June 2016 to Mar 2020. RESULTS: Forty-nine patients (44.5%) underwent diaphragmatic peritonectomy (34 in PDS and 15 in IDS, p=0.005), while 38 (34.5%) underwent large bowel resection (29 in PDS and 9 in IDS, p<0.001). Complete cytoreduction was achieved in 39 patients in PDS and 29 in IDS (65% vs. 58%, p=0.22). Longer operations with more blood loss and extended hospital stay were performed in the PDS group. Ten patients (9.1%) experienced severe complications and in eight patients (7.2%) chemotherapy was delayed. CONCLUSION: More bowel resections and diaphragmatic stripping were performed in the PDS group. End surgical results were similar between groups, with a trend for more complete cytoreduction in PDS.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Neoplasias Ovarianas/cirurgia , Ovário/cirurgia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Ovário/patologia
8.
Ann Surg ; 272(5): 847-854, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32833761

RESUMO

OBJECTIVE: Evaluate at a national level the postoperative mortality (POM), major morbidity (MM) and failure-to-rescue (FTR) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) across time and according to hospital-volume. BACKGROUND: CRS/HIPEC is an effective therapeutic strategy commonly used to treat peritoneal surface malignancies. However, this aggressive approach has the reputation to be associated with a high POM and MM. METHODS: All patients treated with CRS/HIPEC between 2009 and 2018 in France were identified through a national medical database. Patients and perioperative outcomes were analyzed. A cut-off value of the annual CRS/HIPEC caseload affecting the 90-day POM was calculated using the Chi-squared Automatic Interaction Detector method. A multivariable logistic model was used to identify factors mediating 90-day POM. RESULTS: A total of 7476 CRS/HIPEC were analyzed. Median age was 59 years with a mean Elixhauser comorbidity index of 3.1, both increasing over time (P < 0.001). Ninety-day POM was 2.6%. MM occurred in 44.2% with a FTR rate of 5.1%. The threshold of CRS/HIPEC number per center per year above which the 90-day POM was significantly reduced was 45 (3.2% vs 1.9%, P = 0.01). High-volume centers had more extended surgery (P < 0.001) with increased MM (55.8% vs 40.4%, P < 0.001) but lower FTR (3.1% vs 6.3%, P = 0.001). After multivariate analysis, independent factors associated with 90-day POM were: age >70 years (P = 0.002), Elixhauser comorbidity index ≥8 (P = 0.006), lower gastro-intestinal origin, (P < 0.010), MM (P < 0.001), and <45 procedures/yr (P = 0.002). CONCLUSION: In France, CRS/HIPEC is a safe procedure with an acceptable 90-day POM that could even be improved through centralization in high-volume centers.


Assuntos
Competência Clínica , Procedimentos Cirúrgicos de Citorredução , Falha da Terapia de Resgate , Hipertermia Induzida , Oncologia/educação , Neoplasias Peritoneais/terapia , Idoso , Terapia Combinada , Comorbidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/mortalidade , Complicações Pós-Operatórias/prevenção & controle
9.
Ugeskr Laeger ; 182(29)2020 07 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32734862

RESUMO

This is a case report of a 68-year-old female referred to the SARS-CoV-2 ward with one week of intermittent fever and three days of progressive loss of vision. Laboratory work-up revealed severe coagulopathy, thrombocytopenia and hyperleukocytosis. MRI showed multiple ischaemic cortical lesions. Acute treatment with all-trans retinoic acid and cytoreduction was started and coagulation parameters corrected. Patients referred to pandemic wards must undergo stringent examination and be referred for further evaluation irrespective of suspected severe acute respiratory syndrome coronavirus-2 infection.


Assuntos
Cegueira/virologia , Infecções por Coronavirus/diagnóstico , Febre/virologia , Leucemia Promielocítica Aguda/complicações , Pneumonia Viral/diagnóstico , Idoso , Betacoronavirus , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações , Tretinoína/uso terapêutico
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 521-528, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854476

RESUMO

Objective: To introduce the technical essentials of cytoreduction surgery (CRS) with extensive peritonectomy ("rolling carpet" surgery) in stage Ⅲc epithelial ovarian cancer (EOC) and evaluate the feasibility and safety of the operation by analyzing the incidence of surgical complications and perioperative mortality. Methods: From December 2017 to December 2019, 30 patients with stage IIIc EOC who underwent "rolled carpet" CRS and 30 patients who underwent traditional CRS at the same period in Sichuan Cancer Hospital were collected. To summarize the key points of "rolled carpet" CRS operation technology, i.e. the extraperitoneal space was the cut path of ovarian cancer operation, and the tumor in the pelvic cavity was dissociated from the extraperitoneal space of the pelvic cavity. The tumor in the pelvic cavity and all the implants or potential metastases on the parietal peritoneum were removed completely. The clinical and pathological characteristics between the two groups were analyzed retrospectively, and the feasibility and safety of "rolling carpet" CRS were evaluated by comparing the operation related indexes and the occurrence of surgical complications between the two groups. Results: (1) Clinicopathological features: the age of patients in "rolling carpet" CRS group and traditional CRS group were respectively (55.4±9.6) and (54.6±9.5) years, and the median peritoneal cancer index (PCI) was 12 (range, 4-24) and 10 (range, 5-18), respectively. There were no statistical significance between the two groups (all P>0.05). (2) Operation related indexes: in the "rolled carpet" CRS group, all patients (100%, 30/30) were performed optimal CRS, reaching completeness of cytoreduction score (CC score), named CC-0 score, and there was no visible residual lesion after operation. While, in the traditional CRS group, 23 patients (77%, 23/30) reached CC-0 score, 5 cases (17%, 6/30) reached CC-1 score, 2 cases (7%, 2/30) reached CC-2 score, and there were statistical significance between the two groups (P=0.011). The median surgical time was 315 minutes (range, 252-446 minutes) vs 268 minutes (range, 215-372 minutes), the median intraoperative blood loss was 589 ml (range, 300-900 ml) vs 450 ml (range, 250-800 ml), the median ICU hospital stay time was 2 days (range, 1-7 days) vs 1 day (range, 0-5 days), the median total hospital stay time was 14 days (range, 9-17 days) vs 12 days (range, 7-15 days). There were no statistical significance between the two groups (all P>0.05). (3) Surgical complications: there were respectively 5 cases (17%, 5/30) and 3 cases (10%, 3/30) complications with Clavien-Dindo grading Ⅰ-Ⅱ, which was significant no difference between the "rolled carpet" CRS group and the traditional CRS groups (P>0.05). No re-operations were needed and the operative mortality was 0. Conclusion: It is safe and feasible to perform "rolled carpet" CRS in patients with advanced stage Ⅲc EOC with peritoneum implantation and metastasis, which could achieve optimal CRS, and has an acceptable incidence of perioperative complications, no perioperative death.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Carcinoma Epitelial do Ovário/patologia , Feminino , Humanos , Hipertermia Induzida , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Peritônio/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Brain Tumor Pathol ; 37(4): 165-170, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32740753

RESUMO

Solitary fibrous tumor/hemangiopericytoma is a mesenchymal tumor that originates from a common NAB2-STAT6 fusion gene and is known to very rarely demonstrate dedifferentiation in the pattern of local recurrence or distant metastasis. Here we describe for the first time a rare case of intracranial dedifferentiated solitary fibrous tumor/hemangiopericytoma with osteosarcoma components that developed in an 84-year-old man after frequent gamma knife radiosurgery over a 14-year period. We performed tumor-debulking and gamma knife radiosurgery, but unfortunately the patient died shortly after the development of dedifferentiation. There is no established treatment for dedifferentiated cases due to the rare histology and limited published data, and therefore further accumulation of histological and genetic profiles is necessary to develop novel target gene therapies.


Assuntos
Neoplasias Encefálicas/patologia , Desdiferenciação Celular , Hemangiopericitoma/patologia , Hemangiopericitoma/cirurgia , Segunda Neoplasia Primária , Osteossarcoma/patologia , Tumores Fibrosos Solitários/patologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Procedimentos Cirúrgicos de Citorredução , Progressão da Doença , Evolução Fatal , Fusão Gênica , Hemangiopericitoma/genética , Humanos , Masculino , Procedimentos Neurocirúrgicos , Osteossarcoma/genética , Osteossarcoma/cirurgia , Radiocirurgia , Doenças Raras , Proteínas Repressoras/genética , Fator de Transcrição STAT6/genética , Tumores Fibrosos Solitários/genética , Tumores Fibrosos Solitários/cirurgia
12.
Arch Gynecol Obstet ; 302(4): 793-799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32653946

RESUMO

PURPOSE: Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy. METHODS: A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic databases, following the MOOSE guidelines. The terms "Cytoreductive Surgery", "Hyperthermic Intraperitoneal Chemotherapy", "Peritoneal Carcinomatosis", "Pregnancy", "Fertility Preservation", "Conception" were used. All study designs were eligible for inclusion in the final analysis. RESULTS: In total, 7 studies (5 case reports and 2 case series) were included in the final analysis, reporting on 14 successful pregnancies after CRS and HIPEC. The mean age of patients at the time of CRS/HIPEC was 28.8 ± 5.9 years (range 18-36), while the mean interval between CRS/HIPEC and pregnancy was 29.6 ± 20.3 months (range 9-80 months). Nine patients were treated for pseudomyxoma peritonei, four for primary peritoneal mesothelioma and one for endocrine carcinoma. Mean Peritoneal Carcinomatosis Index was 9.8 ± 7.8 (range 1-26). All patients underwent fertility-sparing CRS (preservation of at least one ovary and the uterus). In 12 cases, conception was spontaneous, whereas two pregnancies were achieved through in-vitro fertilization. One patient developed gestational hypertension, while two labors were preterm. Mean disease-free survival was 64.1 months (range 24-106 months). CONCLUSION: A successful pregnancy is feasible in selected patients, after CRS and HIPEC. Assisted reproduction techniques (IVF using frozen oocytes or frozen embryos, ovarian tissue cryopreservation, preoperative treatment with GnRH analogs) should be discussed pre-operatively with the patient, without, however, compromising overall survival or risking locoregional recurrence.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Preservação da Fertilidade , Hipertermia Induzida/efeitos adversos , Neoplasias Peritoneais/terapia , Peritônio/cirurgia , Técnicas de Reprodução Assistida , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Intervalo Livre de Doença , Neoplasias das Glândulas Endócrinas , Feminino , Humanos , Hipertermia Induzida/métodos , Lactente , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Peritoneais/patologia , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/terapia , Resultado do Tratamento
15.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(4): 546-551, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32691565

RESUMO

Objective: To explore whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN), is more beneficial for patients with locally T 1 stage metastatic renal cell carcinoma (mRCC). Methods: We retrospectively collected the data ofthe patients with locally T 1 stage mRCC ( n=934) from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was conducted to identify the determinants of cPN. Propensity-score match (PSM) was used to diminish the confounder. Kaplan-Meier survival analyses was performed and multivariable Cox proportional hazards model was used to evaluate the effect of cPN and cRN on overall survival (OS) and cancer specific survival (CSS). Results: Among the 934 patients, 142 (15.2%) received cPN and 792 (84.8%) received cRN. Before PSM, both OS and CSS in cPN group were better in Kaplan-Meier analysis (log rank test, each P< 0.01). In a survival analysis of propensity-score matched 141 pairs of patients, cPN was still associated with improved OS and CSS compared with cRN (log rank test, each P< 0.01). After PSM, the 2-year OS were 61.7% and 74.4%, and 5-year OS were 35.6% and 59.2% in the cRN and cPN cohorts respectively. Cox proportional hazards model confirmed cPN the independent risk factor of both OS and CSS. Conclusion: For mRCC patients with locally T 1 stage, cPN may gain an OS and CSS benefit compared with cRN.


Assuntos
Carcinoma de Células Renais , Procedimentos Cirúrgicos de Citorredução , Neoplasias Renais , Nefrectomia , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução/normas , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Nefrectomia/normas , Estudos Retrospectivos
16.
Rev Col Bras Cir ; 47: e20202534, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667582

RESUMO

INTRODUCTION: to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. METHODS: a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. RESULTS: fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. CONCLUSIONS: we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Hipertermia Induzida/métodos , Neoplasias Ovarianas/cirurgia , Qualidade de Vida , Adulto , Procedimentos Cirúrgicos de Citorredução/psicologia , Feminino , Humanos , Hipertermia Induzida/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Carga Tumoral
17.
Anticancer Res ; 40(7): 3925-3929, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620633

RESUMO

BACKGROUND/AIM: CHORUS and EORTC55971 trials demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery (IDS) or primary debulking surgery (PDS) offered the same survival rates. These trials have since been criticised due to poor surgical complexity. We compared overall (OS), progression free (PFS), and platinum sensitivity in advanced ovarian cancer (AOC) patients undergoing IDS or PDS, who had received either intermediate or high complexity surgery to achieve complete cytoreduction. PATIENTS AND METHODS: All patients with AOC treated between February 2014 and May 2019 obtaining complete cytoreduction with intermediate/high surgical complexity were included. Recurrence was defined according to GCIG criteria on radiological findings and/or CA125 levels. RESULTS: Seventy-one patients (38 PDS and 33 IDS) with full recurrence data were identified. No statistical difference was seen between groups in OS, PFS or platinum sensitive interval. CONCLUSION: PDS or IDS were both acceptable treatment options for AOC, showing similar survival and platinum sensitivity outcomes in patients undergoing intermediate or high complexity surgery.


Assuntos
Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/cirurgia , Compostos Organoplatínicos/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Idoso , Carcinoma Epitelial do Ovário/patologia , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Ovarianas/patologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Taxa de Sobrevida
18.
Medicine (Baltimore) ; 99(29): e21127, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702865

RESUMO

RATIONALE: Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women. PATIENT CONCERNS: We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed. DIAGNOSES: The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer. INTERVENTIONS: Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed. OUTCOMES: The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy. LESSONS: Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Ovarianas/cirurgia , Adulto , Feminino , Humanos , Histerectomia/métodos , Linfonodos/patologia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Ovariectomia/métodos , Ovário/patologia , Gravidez , Segundo Trimestre da Gravidez , Romênia
19.
Urol Clin North Am ; 47(3): 319-327, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600534

RESUMO

Variant histology renal cell carcinoma (vRCC) encompasses rare non-clear cell subtypes that have long been associated with poor prognosis and minimal response to therapies targeting vascular endothelial growth factor and its receptor. Molecular advances have helped classify vRCC into distinct entities and identify putative targetable driver alterations, such as MET in papillary subtypes. More have since been identified in other vRCC subtypes, including alterations of tumor metabolism, chromatin remodeling genes, cell-cycle genes, and inactivation of tumor suppressors such as TP53 or NF2. New targeted therapies, as well as immune checkpoint inhibitors, have been in development and yielded encouraging results. Collaborative clinical trials will be an essential step toward better implementation of these regimens in clinical practice.


Assuntos
Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Antineoplásicos Imunológicos/uso terapêutico , Procedimentos Cirúrgicos de Citorredução , Humanos , Terapia de Alvo Molecular , Nefrectomia
20.
Urol Clin North Am ; 47(3): 359-370, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600537

RESUMO

The role for cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) has evolved with advancements in systemic therapy. During the cytokine-based immunotherapy era, CN provided a clear survival benefit and was considered standard of care in management of mRCC. The development of targeted systemic therapy directed at the vascular endothelial growth factor pathway altered the treatment paradigm and accentuated the importance of risk stratification in treatment selection. This article reviews the literature evaluating the benefit of CN during the evolution of systemic therapy and provides clinical recommendations for current utilization of CN in patients with mRCC.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Procedimentos Cirúrgicos de Citorredução , Inibidores Enzimáticos/uso terapêutico , Humanos , Imunoterapia , Neoplasias Renais/tratamento farmacológico , Terapia de Alvo Molecular , Recidiva Local de Neoplasia/prevenção & controle , Nefrectomia , Proteínas Tirosina Quinases/antagonistas & inibidores , Risco , Serina-Treonina Quinases TOR/antagonistas & inibidores
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