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1.
Zhonghua Wai Ke Za Zhi ; 58(1): 5-8, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902161

RESUMO

As tumors originated from mesenchymal tissue, gastrointestinal stromal tumors (GIST) has its own typical history. For the idea of treatment for GIST at different historical periods, the role and value of surgery for the treatment of GIST keep changing. Laparoscopy and endoscopy will have the role they deserved. With the understanding of pathogenesis of GIST, targeted chemotherapy will be more and more accurate and individualized. How to improve the overall therapeutic effect of GIST, especially for the patients with the high risk and drug-resistance, is the dilemma and challenges for the surgeons.


Assuntos
Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Terapia Combinada , Neoplasias Gastrointestinais/tratamento farmacológico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Laparoscopia
2.
Zhonghua Wai Ke Za Zhi ; 58(1): 52-56, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902171

RESUMO

Recently, with the development and widespread application of total mesorectal excision and neoadjuvant chemoradiotherapy, the long-term overall survival and disease-free survival of patients with middle & low rectal cancer have been greatly improved. Moreover, there are also researches in minimally invasive techniques, such as laparoscopy and robotic surgical system in the radical rectal surgery, as well as the combination of tumor molecular targeting markers and gene sequencing technology. Nowadays, the treatment of rectal cancer has entered a new era of individualized precise medicine. However, there are still some controversies in lateral lymph node dissection. The criteria of diagnosis and treatment, neoadjuvant therapy, indications of lateral lymph node dissection, the area of dissection and neuroprotection are still unsatisfactory. It is necessary to explore the personalized treatment strategies of lateral lymph node dissection in the precise medical era.


Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retais/patologia , Terapia Combinada , Humanos , Metástase Linfática , Pelve/patologia , Pelve/cirurgia , Medicina de Precisão , Neoplasias Retais/cirurgia
3.
Anticancer Res ; 40(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892548

RESUMO

BACKGROUND/AIM: The treatment of colorectal liver metastases is challenging and requires multidisciplinary strategies. Unfortunately, only 25% of patients with colorectal liver metastases are eligible for liver resection. Due to the variety of therapeutic approaches, this percentage has increased; however, at the same time, the definition of resectability has become complex. The aim of this review was to provide an overview of current surgical therapies for colorectal liver metastases. MATERIALS AND METHODS: Relevant studies published before June 2019 were identified using PubMed. A comprehensive review of the current literature regarding the impact of and innovations in the therapy of colorectal liver metastases was carried out. RESULTS: The major advances in the resectability of colorectal liver metastases were effective chemotherapy regimens and preoperative liver volume modulation techniques. In addition, health professionals face rapid technical developments in interventional local therapies, minimally invasive surgery, robot-assisted surgery and even liver transplantation. CONCLUSION: Currently, liver metastases from colorectal cancer are considered a chronic disease. In cases of advanced colorectal liver metastases, the definition of resectability and the indications for surgical treatment should be exclusively determined by experienced hepatobiliary surgeons.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Doença Crônica , Neoplasias Colorretais/epidemiologia , Terapia Combinada , Gerenciamento Clínico , Humanos , Incidência , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Resultado do Tratamento
4.
Anticancer Res ; 40(1): 75-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892554

RESUMO

BACKGROUND/AIM: The aim of the present study was to compare human epidermal growth factor receptor 2 (HER2) expression before and after trastuzumab-based chemotherapy in patients with advanced HER2-positive gastric cancer. MATERIALS AND METHODS: We assessed HER2 expression using immunohistochemistry and/or fluorescence in situ hybridization in pre-treatment biopsied specimens and post-treatment resected specimens obtained from seven patients with advanced HER2-positive gastric cancer receiving trastuzumab-based chemotherapy. RESULTS: Four patients maintained the HER2-positive status and three patients had a change in HER2 expression from positive to negative. In patients showing the loss of HER2 expression after treatments, HER2-positive tumor cells with a dominant histological type disappeared, and HER2-negative tumor cells with another dominant histological type were identified. CONCLUSION: HER2 expression can change after trastuzumab-based chemotherapy in patients with advanced HER2-positive gastric cancer. Continuous monitoring of HER2 expression after treatments may be utilized to determine whether the continued use of trastuzumab is advisable.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Receptor ErbB-2/antagonistas & inibidores , Receptor ErbB-2/genética , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/genética , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biomarcadores Tumorais , Terapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Imagem Multimodal/métodos , Metástase Neoplásica , Estadiamento de Neoplasias , Receptor ErbB-2/metabolismo , Recidiva , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo , Trastuzumab/administração & dosagem , Resultado do Tratamento
5.
Surg Clin North Am ; 100(1): 141-159, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31753109

RESUMO

Recent advances in effective medical therapies have markedly improved the prognosis for patients with advanced melanoma. This article aims to highlight the current era of integrated multidisciplinary care of patients with advanced melanoma by outlining current approved therapies, including immunotherapy, targeted therapy, radiation therapy, and other strategies used in both the adjuvant and the neoadjuvant setting as well as the evolving role of surgical intervention in the changing landscape of advanced melanoma.


Assuntos
Melanoma/terapia , Neoplasias Cutâneas/terapia , Antineoplásicos Imunológicos/uso terapêutico , Terapia Combinada , Humanos , Imunoterapia , Melanoma/patologia , Prognóstico , Neoplasias Cutâneas/patologia
6.
J Colloid Interface Sci ; 559: 51-64, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610305

RESUMO

Aiming at the inefficiency and toxicity in traditional antitumor therapy, a novel multifunctional nanoplatform was constructed based on hollow mesoporous carbon (HMC) to achieve triple stimuli response and dual model antitumor therapy via chemo-photothermal synergistic effect. HMC was used as an ideal nanovehicle with a high drug loading efficiency as well as a near-infrared (NIR) photothermal conversion agent for photothermal therapy. Acid-dissoluble, luminescent ZnO quantum dots (QDs) were used as the proper sealing agents for the mesopores of HMC, conjugated to HMC via disulfide linkage to prevent drug (doxorubicin, abbreviated as Dox) premature release from Dox/HMC-SS-ZnO. After cellular endocytosis, the Dox was released in a pH, GSH and NIR laser triple stimuli-responsive manner to realize accurate drug delivery. Moreover, the local hyperthermia effect induced by NIR irradiation could promote the drug release, enhance cell sensitivity to chemotherapeutic agents, and also directly kill cancer cells. As expected, Dox/HMC-SS-ZnO exhibited a high drug loading capacity of 43%, well response to triple stimuli and excellent photothermal conversion efficiency η of 29.7%. The therapeutic efficacy in 4T1 cells and multicellular tumor spheroids (MCTSs) demonstrated that Dox/HMC-SS-ZnO + NIR had satisfactory chemo-photothermal synergistic effect with a combination index (CI) of 0.532. The cell apoptosis rate of the combined treatment group was more than 95%. The biodistribution and pharmacodynamics studies showed its biosecurity to normal tissues and synergistic inhibition effect to tumor cells. These distinguished results indicated that the Dox/HMC-SS-ZnO nanoplatform is potential to realize efficient triple stimuli-responsive drug delivery and dual model chemo-photothermal synergistic antitumor therapy.


Assuntos
Antineoplásicos/química , Carbono/química , Terapia Combinada/métodos , Portadores de Fármacos/química , Nanopartículas/química , Pontos Quânticos/química , Óxido de Zinco/química , Animais , Antineoplásicos/farmacocinética , Apoptose/efeitos dos fármacos , Materiais Biocompatíveis/química , Linhagem Celular Tumoral , Permeabilidade da Membrana Celular , Sobrevivência Celular/efeitos dos fármacos , Doxorrubicina/química , Liberação Controlada de Fármacos , Corantes Fluorescentes/química , Humanos , Raios Infravermelhos , Camundongos Endogâmicos BALB C , Fototerapia/métodos , Porosidade , Propriedades de Superfície , Distribuição Tecidual , Óxido de Zinco/farmacocinética
9.
Br J Radiol ; 93(1105): 20190455, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31617737

RESUMO

OBJECTIVE: This study explored the value of serial 18-fludeoxyglucose-positron emission tomography (18F-FDG-PET/CT) in predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (NCRT) and surgery. METHODS: We prospectively studied 46 patients with LARC who underwent NCRT and surgery. 18F-FDG-PET/CT scans were performed at three time-points before surgery (pre-NCRT-PET1, during NCRT-PET2 and following completion of NCRT-PET3). The following semi-quantitative PET parameters were analysed at each time point: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG). Absolute and percentage changes in these parameters were analysed between time points. Statistical analysis consisted of median tests, Cox regression and Kaplan-Meier analysis for DFS. RESULTS: The median follow-up time was 24 months. A reduction in PET parameters showed statistically significant differences for patients with recurrence compared to those without; percentage changes in MTV between PET1 and PET3 (cut-off: 87%, p = 0.023), percentage changes in TLG between PET1 and PET3 (cut-off: 94%, p = 0.02) and absolute change in MTV PET1 and PET2 (cut-off: 10.25, p = 0.001).An absolute reduction in MTV between PET1 and PET3 (p=0.013), a percentage reduction in TLG between PET1 and PET2 (p=0.021), SUVmax and SUVmean at PET2 (p = 0.01, p = 0.027 respectively)were also prognostic indicators of recurrence.MTV percentage change between PET1 and PET2 and SUVmean percentage change between PET1 and PET3 were also trending towards significance (p = 0.052, p = 0.053 respectively). CONCLUSION: Serial 18F-FDG-PET/CT is a potentially reliable non-invasive method to predict recurrence in patients with LARC. Volumetric parameters were the best predictors. This could allow risk-stratification in patients who may benefit from conservative management. ADVANCES IN KNOWLEDGE: This paper will add to the literature in risk-stratifying patients with LARC based on prognosis, using 18F-FDG-PET/CT. This may improve patient outcomes by selecting suitable candidates for conservative management.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Idoso , Quimiorradioterapia , Terapia Combinada , Feminino , Fluordesoxiglucose F18 , Glicólise , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Compostos Radiofarmacêuticos , Neoplasias Retais/patologia , Carga Tumoral
10.
Medicine (Baltimore) ; 98(50): e18089, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852067

RESUMO

RATIONAL: The growing population of young cancer survivors and a trend toward postponing pregnancy until later years in life are leading to a deeper attention towards understanding treatment-induced sequelae, and, in particular, the effects of cancer and/or treatment on fertility. Nowadays, the infertility risks potentially associated with molecular targeted therapies are not established, and clinical reports are sparse. Moreover, the increasing use of molecular targeted drugs in the adjuvant setting and in diseases with better prognosis makes preservation of fertility a major topic in current research. PATIENT'S CONCERNS: Here, we report the case of an 18-year-old woman, with a 3-cm superficial lump of the right breast, who had no remarkable family or medical history. Menarche had occurred at the age of 14 years, with normal regular periods. DIAGNOSIS: High-grade angiosarcoma, with metastatic progression and multiple relapse, was diagnosed. INTERVENTIONS: After diagnosis, right radical mastectomy was carried out with no evidence of residual disease. No adjuvant treatment was delivered. Lymph node metastasis were found later and chemotherapy with doxorubicin 25 mg/m/day and ifosfamide 1 g/m/day (both on days 1-3) every 21 days was administered. During treatment, the patient reported menstrual irregularities but no amenorrhea. Due to further local relapse a few years later, the patient was treated for progressive metastatic disease with gemcitabine 1000 mg/m on days 1 and 8 every 21 days for 6 cycles, and underwent surgery, followed by pegylated liposomal doxorubicin, 50 mg/m on day 1 every 28 days. After further disease progression 5 years after first diagnosis, pazopanib was administered at a dose of 800 mg daily for 10 months. OUTCOMES: The patient experienced a transient ovarian insufficiency possibly due to pazopanib. Since amenorrhea developed within 2 months from the initiation of pazopanib treatment and menses returned regularly only after discontinuation of the treatment itself. LESSONS: This is the first case report that strongly suggests a correlation between pazopanib exposure and development of ovarian insufficiency. Our case tantalizes to inspire additional preclinical and clinical research on the true incidence, possible dose dependence, and reversibility of pazopanib (and other TKIs) -induced ovarian failure.


Assuntos
Neoplasias da Mama/terapia , Hemangiossarcoma/terapia , Insuficiência Ovariana Primária/induzido quimicamente , Pirimidinas/efeitos adversos , Sulfonamidas/efeitos adversos , Adolescente , Terapia Combinada , Endossonografia/métodos , Feminino , Humanos , Mastectomia , Insuficiência Ovariana Primária/diagnóstico , Pirimidinas/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Sulfonamidas/uso terapêutico , Vagina
11.
Medicine (Baltimore) ; 98(50): e18093, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852068

RESUMO

RATIONALE: Papillary renal cell carcinoma (PRCC) accounts for about 15% to 20% of renal cell carcinoma and is histologically distinguished in type I and type II. The last one is associated with poorer prognosis.Treatment options for PRCC patients are surgery, immunotherapy, revolutionized by Nivolumab, and other target-therapy with an improvement in overall survival. Heterogenous response and a pseudo-progression may be observed in the initial phase of biological treatment that could induce premature discontinuation. PATIENT CONCERNS: We present the case of a 44-year-old woman with left cervical palpable mass increased in size and without concomitant disease or previous surgery. DIAGNOSIS: Neck ultrasonography, contrast-enhanced Computed Tomography, and 18F-FDG PET/CT were performed with the detection of lymph nodes involvement and a left renal lesion. INTERVENTIONS: The patients underwent left radical nephrectomy and homolateral cervical and para-aortic lymphadenectomy, with histological diagnosis of PRCC, type II. After disease relapse, the inter-aortocaval lymph node was laparoscopically removed. Following the detection of further disease relapse in several lymph nodes and the lung, several lines of target-therapy were started; then disease progression and worsening of clinical and hematological status led us to start Nivolumab as last-line therapy. OUTCOMES: A heterogeneous response to therapies was documented with morphological and nuclear medicine imaging, however the concomitant deterioration of performance status and liver function led to discontinuation of Nivolumab; then the patient died, 30 months after diagnosis. LESSONS: Here we describe the clinical case and radiological and nuclear medicine imaging investigations performed by our patient, highlighting that 18F-FDG PET/CT shows greater adequacy in assessing the response to therapy, avoiding premature drug discontinuation, and ensuring better management of a patient with advanced PRCC.


Assuntos
Neoplasias Ósseas/diagnóstico , Carcinoma de Células Renais/diagnóstico , Fluordesoxiglucose F18/farmacologia , Neoplasias Renais/diagnóstico , Imagem Multimodal , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Neoplasias Renais/terapia , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática , Pescoço , Estadiamento de Neoplasias , Nefrectomia/métodos , Compostos Radiofarmacêuticos/farmacologia , Vértebras Torácicas
12.
Medicine (Baltimore) ; 98(50): e18196, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852076

RESUMO

This study aimed at investigating the prevalence of anxiety and depression, and their risk factors as well as their correlation with prognosis in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients.A total of 180 R/R AML patients were enrolled and their anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS) before treatment. Besides, HADS was also evaluated in 180 de novo AML patients prior treatment and 180 healthy controls (HCs), respectively.Both the HADS-Anxiety and HADS-Depression scores were increased in R/R AML patients compared with de novo AML patients and HCs (all P < .001). Meanwhile, the prevalence of anxiety and depression was 53.9% and 45.6% in R/R AML patients, which were also greatly higher compared with de novo AML patients and HCs (all P < .01). Regarding risk factors, higher Eastern Cooperative Oncology Group score and lines of salvage therapy were correlated with anxiety and depression in R/R AML patients (all P < .05). Furthermore, anxiety and depression were associated with shorter overall survival (OS) in R/R AML patients (all P < .05), while no association of different degrees of anxiety and depression with OS was observed (all P > .05).Anxiety and depression are highly prevalent and implicated in the management and prognosis of R/R AML.


Assuntos
Ansiedade/etiologia , Depressão/epidemiologia , Leucemia Mieloide Aguda/complicações , Indução de Remissão/métodos , Medição de Risco/métodos , Ansiedade/epidemiologia , China/epidemiologia , Terapia Combinada , Depressão/etiologia , Feminino , Seguimentos , Humanos , Incidência , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
N Engl J Med ; 381(25): 2416-2428, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851799

RESUMO

BACKGROUND: Olaparib has shown significant clinical benefit as maintenance therapy in women with newly diagnosed advanced ovarian cancer with a BRCA mutation. The effect of combining maintenance olaparib and bevacizumab in patients regardless of BRCA mutation status is unknown. METHODS: We conducted a randomized, double-blind, international phase 3 trial. Eligible patients had newly diagnosed, advanced, high-grade ovarian cancer and were having a response after first-line platinum-taxane chemotherapy plus bevacizumab. Patients were eligible regardless of surgical outcome or BRCA mutation status. Patients were randomly assigned in a 2:1 ratio to receive olaparib tablets (300 mg twice daily) or placebo for up to 24 months; all the patients received bevacizumab at a dose of 15 mg per kilogram of body weight every 3 weeks for up to 15 months in total. The primary end point was the time from randomization until investigator-assessed disease progression or death. RESULTS: Of the 806 patients who underwent randomization, 537 were assigned to receive olaparib and 269 to receive placebo. After a median follow-up of 22.9 months, the median progression-free survival was 22.1 months with olaparib plus bevacizumab and 16.6 months with placebo plus bevacizumab (hazard ratio for disease progression or death, 0.59; 95% confidence interval [CI], 0.49 to 0.72; P<0.001). The hazard ratio (olaparib group vs. placebo group) for disease progression or death was 0.33 (95% CI, 0.25 to 0.45) in patients with tumors positive for homologous-recombination deficiency (HRD), including tumors that had BRCA mutations (median progression-free survival, 37.2 vs. 17.7 months), and 0.43 (95% CI, 0.28 to 0.66) in patients with HRD-positive tumors that did not have BRCA mutations (median progression-free survival, 28.1 vs. 16.6 months). Adverse events were consistent with the established safety profiles of olaparib and bevacizumab. CONCLUSIONS: In patients with advanced ovarian cancer receiving first-line standard therapy including bevacizumab, the addition of maintenance olaparib provided a significant progression-free survival benefit, which was substantial in patients with HRD-positive tumors, including those without a BRCA mutation. (Funded by ARCAGY Research and others; PAOLA-1 ClinicalTrials.gov number, NCT02477644.).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Ftalazinas/administração & dosagem , Piperazinas/administração & dosagem , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/efeitos adversos , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Quimioterapia de Manutenção , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/cirurgia , Ftalazinas/efeitos adversos , Piperazinas/efeitos adversos , Inibidores de Poli(ADP-Ribose) Polimerases/efeitos adversos , Intervalo Livre de Progressão , Qualidade de Vida
14.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 848-853, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874475

RESUMO

Objective: To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods: A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results: The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions: The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/induzido quimicamente , Endométrio/efeitos dos fármacos , Moduladores de Receptor Estrogênico/efeitos adversos , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Hemorragia Uterina/etiologia , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Terapia Combinada , Hiperplasia Endometrial/epidemiologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Endométrio/patologia , Moduladores de Receptor Estrogênico/uso terapêutico , Feminino , Humanos , Estudos Retrospectivos , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Índice de Gravidade de Doença , Ultrassonografia
15.
Clin Exp Rheumatol ; 37 Suppl 121(6): 125-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856938

RESUMO

OBJECTIVES: Systemic therapy aimed at suppressing the diffuse inflammation in the vessel wall is the major treatment modality for venous thrombosis in Behçet's syndrome (BS). Endovascular and/or surgical interventions are also used. We here report five patients who were referred to our clinic after having such interventions and also present a literature review to assess the outcome of invasive procedures for venous thrombosis in BS. METHODS: Our patients were presented and a literature search for endovascular and/or surgical interventions in Pub-Med was performed. Recanalisation, reocclusion or other complications were assessed as outcomes. RESULTS: Five BS patients with lower extremity thrombosis were referred to our clinic with post thrombotic syndrome due to incomplete recanalisation or infectious complication after endovascular interventions. Twenty-one articles reporting on 36 patients were found suitable for review. There were totally 21 lower extremity venous intervention cases, 14 of which had failure such as complication, reocclusion or incomplete recanalisation. Reocclusions occurred in 10 patients and reinterventions to 8 of them could restore flow only in 4 cases. Ileal infarct and vena cava wall-duodenal perforation were major complications. Invasive procedures of 8 abdominal thrombosis cases resulted with death due to ileus in one patient, and reocclusion in another. Seven of the 12 upper extremity/superior vena cava thrombosis cases resulted with reocclusions. CONCLUSIONS: Endovascular and surgical interventions seemed to be unsuccessful because of recurrent infectious and vascular complications in 22 (53.6%) of 41 patients with venous thrombosis. The indication of these procedures is controversial. Their economic burden on the healthcare system must be considered.


Assuntos
Síndrome de Behçet , Trombose Venosa , Síndrome de Behçet/complicações , Terapia Combinada , Humanos , Terapia Trombolítica , Trombose , Resultado do Tratamento , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1115-1117, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874525

RESUMO

Hyperthermic intraperitoneal chemotherapy (HIPEC) has a unique effect on the prevention and treatment of peritoneal metastasis from malignancies. Recently, the first prospective, multicenter, randomized controlled clinical trial of HIPEC to prevent the development of peritoneal metastasis after curative surgery for patients with locally advanced colon cancer was published in the "Lancet Gastroenterol Hepatol" (COLOPEC). Regrettably, no significant difference was observed in 18-month peritoneal metastasis-free survival between postoperative adjuvant HIPEC and standard systemic chemotherapy for patients with T4 stage or perforated colon cancer. However, we wonder whether we might achieve better outcomes by further optimizing the following issues: (1) We propose that the inclusion criteria for that trial may not be entirely reasonable, which included pT4N0-2M0 and perforation. Additionally, we found that 91% of patients underwent HIPEC 5-8 weeks after primary tumor resection. (2) The imbalance in starting time of postoperative systemic chemotherapy between the two groups may have a negative impact.(3) Nine patients with peritoneal metastasis preceding HIPEC might weaken the potential efficacy of HIPEC. (4) We wonder whether HIPEC using high-dese oxaliplatin (460 mg/m(2)) perfusing 30 minutes for one cycle is the optimal regimen. Therefore, we are planning to conduct a randomized controlled trial (HIPEC-06) in accordcance with the characteristics of Chinese patients, to explore the clinical efficacy of curative surgery combined with HIPEC in the treatment of cT4 colorectal cancer.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Colorretais/terapia , Hipertermia Induzida/métodos , Oxaliplatina/administração & dosagem , Neoplasias Peritoneais/terapia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Terapia Combinada , Humanos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia
17.
Medicine (Baltimore) ; 98(51): e18484, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861031

RESUMO

Although induction chemotherapy (IC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) is the new standard treatment option in locoregionally advanced nasopharyngeal carcinoma (NPC), many patients fail to receive CC. The aim of this study was to investigate long-term survival outcomes and toxicities in these patients who are treated with IC before IMRT without CC.We retrospectively reviewed 332 untreated, newly diagnosed locoregionally advanced NPC patients who received IC before IMRT alone at our institution from May 2008 through April 2014. The IC was administered every 3 weeks for 1 to 4 cycles. Acute and late radiation-related toxicities were graded according to the acute and late radiation morbidity scoring criteria of the radiation therapy oncology group. The accumulated survival was calculated according to the Kaplan-Meier method. The log-rank test was used to compare the difference in survival.With a median follow-up duration of 65 months (range: 8-110 months), the 5-year estimated locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates were 93.4%, 91.7%, 85.8%, and 82.5%, respectively. Older age and advanced T stage were adverse prognostic factors for overall survival, and the absence of comorbidity was a favorable prognostic factor for PFS. However, acceptable acute complications were observed in these patients.IC combined with IMRT alone provides promising long-term survival outcomes with manageable toxicities. Therefore, the omission of CC from the standard treatment did not affect survival outcomes.


Assuntos
Quimioterapia de Indução , Carcinoma Nasofaríngeo/tratamento farmacológico , Neoplasias Nasofaríngeas/tratamento farmacológico , Radioterapia de Intensidade Modulada , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , China/epidemiologia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/mortalidade , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/radioterapia , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
18.
Artigo em Russo | MEDLINE | ID: mdl-31880762

RESUMO

BACKGROUND: According to modern statistics, endometriosis is a disease that occupies the third place among the most problematic diseases of the female reproductive system, since it develops mainly in young women and, therefore, negatively affects their reproductive function. The paper presents the data obtained from a clinical trial of the combination treatment of Stages I-III endometriosis, including those using sanatorium-and-spa aftercare using radon tampons. OBJECTIVE: To identify the most effective treatment for endometriosis. MATERIAL AND METHODS: Examinations were made in 348 women of reproductive age (mean age 30±4 years) with Stages I-III endometriosis. According to the therapy received, the patients were divided into 2 groups: 1) 174 patients who used drug therapy and radon tampons; 2) 174 patients who received only drug therapy. RESULTS: Resultative positive changes were observed in Group 1 patients who received a combination of anti-inflammatory therapy, pathogenetic therapy of endometriosis, and sanatorium spa aftercare with radon tampons. The investigators excluded pain syndrome in 93.7% of cases, dysmenorrhea in 85.2%, and dyspareunia in 100%; menstrual blood loss decreased in 55.6% of patients; pregnancy occurred in 97.1% of women; the psychoemotional background improved in 100% of cases; in 96.2% of cases, subsequent recurrences were not observed (in the study period of 2014-2018). CONCLUSION: The results of the study showed that a comprehensive and stage approach to treating Stages I-III endometriosis is fundamental to success in women's reproductive health.


Assuntos
Terapia Combinada/métodos , Difusão de Inovações , Endometriose/terapia , Adulto , Feminino , Humanos , Gravidez , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(51): e17175, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860944

RESUMO

Annual pancreatic tumor incidence rates have been increasing. We explored pancreatic tumor incidence trends by treatment and clinicopathologic features.Data from the Surveillance, Epidemiology and End Results (SEER) was retrieved to evaluate temporal trends and pancreatic cancer rates from 2000 to 2015. Joinpoint regression analyses were carried out to examine trend differences.Overall, the incidence of pancreatic cancer was on the increase. The initial APC increased at a rate of 2.22% from 2000 to 2012, and increased from 2012 to 2015 at a rate of 9.05%. Joinpoint analyses revealed that trends within different demographics of pancreatic cancer showed different characteristics. The rate of pancreatic cancer also varied with histologic types. In addition, the trends by cancer stage showed significant increase incidences of stage I and II pancreatic cancer from 2000 to 2013 (stage I: APC: 2.71%; stage II: APC: 4.87%). Incidences of patients receiving surgery increased from 2000 to 2008 (APC: 7.55%), 2008 to 2011 (APC: 2.17%) and then there was a significant acceleration from 2011 to 2015 (APC: 10.51%). The incidence of cases in stage II receiving surgery increased significantly from 2004 to 2009 (APC: 9.28%) and 2009 to 2013 (APC: 2.57%). However, for cases in stage I, the incidence of cases with surgery decreased significantly since 2009 (APC: -4.14%). Patients undergoing surgical treatment without chemotherapy and radiotherapy had the higher rates compared with those who received other combined treatments.Pancreatic cancer has been increasing overall, but patterns differ by demographics and clinicopathologic features. Efforts to identify and treat more eligible candidates for curative therapy could be beneficial.


Assuntos
Gerenciamento Clínico , Pancreatectomia/métodos , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Terapia Combinada , Grupos de Populações Continentais , Demografia , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Fatores Sexuais , Análise de Sobrevida , Estados Unidos/epidemiologia
20.
Medicine (Baltimore) ; 98(51): e18016, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860952

RESUMO

INTRODUCTION: Breast metastases from primary colorectal carcinoma are extremely rare, with only 45 cases being reported previously. Since the most common malignancy in the breast and axilla is primary breast cancer regardless of cancer history, non-hematologic metastases may be misdiagnosed initially. Nevertheless, differentiating breast metastases from primary breast cancer is crucial because of their differences in prognosis and management. PATIENT CONCERNS: We present a case of a 44-year-old Asian woman who noticed a new right breast lump after undergoing surgery and chemotherapy for her primary sigmoid colon cancer. DIAGNOSIS: Image and immunohistochemistry findings were consistent with breast metastasis from primary colorectal adenocarcinoma. INTERVENTIONS: The patient underwent breast tumor excision and reinitiated chemotherapy. OUTCOMES: The patient's disease progressed despite the interventions. She passed away 7 months after the detection of breast metastasis. CONCLUSION: When a new breast lesion is detected in patients with colorectal cancer history, the physician should consider the possibility of breast metastasis due to the poor prognosis. If a biopsy is necessary, cancer history should be provided to the clinicians to prevent incorrect pathological interpretation. In establishing the diagnosis, certain immunohistochemical markers have been shown to be sensitive and specific in previously reported cases. The combination of tumor excision and chemotherapy was the most common strategy in managing this condition with inconsistent clinical outcomes.


Assuntos
Adenocarcinoma/secundário , Neoplasias da Mama/secundário , Neoplasias da Mama/terapia , Mastectomia Segmentar/métodos , Neoplasias do Colo Sigmoide/patologia , Adenocarcinoma/cirurgia , Biópsia por Agulha , Neoplasias da Mama/diagnóstico por imagem , Quimioterapia Adjuvante , Colectomia/métodos , Terapia Combinada , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Imuno-Histoquímica , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Neoplasias do Colo Sigmoide/terapia , Tomografia Computadorizada por Raios X/métodos
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