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1.
J Surg Res ; 246: 260-268, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610354

RESUMO

BACKGROUND: Irreversible electroporation (IRE) is a relatively new ablation technique utilized as focal therapy to target areas of significant tumor burden to ablate tumors in situ or improve margins of resection. Its application has largely been reported in the pancreas, liver, kidney, and prostate. Because locoregional therapy is becoming more common, IRE may be a reasonable alternative in additional situations if shown to be safe and efficacious. We have utilized IRE intraoperatively in highly selected patients for adjunctive treatment of primary and metastatic tumors at the time of surgical resection to achieve local control where an R1 resection is clinically felt to be likely. We hypothesize that IRE is a safe and effective adjuvant therapy. Our primary objective was to evaluate the safety of IRE with regard to the effects of other structures within the ablated zone. A secondary objective was to estimate local control rates of locally advanced tumors when IRE was used as an adjunct for margin enhancement. METHODS: This is a retrospective chart review of a prospective database at a single tertiary institution. The study included patients receiving IRE from November 2013 through May 2016 at the time of resection of tumor resection for margin enhancement. Primary tumors included liver, pancreatic, retroperitoneal, extremity, and pelvic tumors. Patients undergoing treatment for palliation or in situ ablation were excluded. RESULTS: Forty patients received IRE for margin enhancement. Median follow-up was 14 mo. Three patients (7.5%) had a local recurrence, and 12 (30%) had a distant recurrence. Adverse events possibly related to IRE are described. CONCLUSIONS: Our institution demonstrated a low local recurrence rate of only 7.5% in patients treated with intraoperative IRE for margin enhancement. This may be a useful adjunct at the time of surgical resection to help achieve local control in difficult areas where an R1 resection is likely. This topic will require further investigation with prospective trials and longer follow-up.


Assuntos
Técnicas de Ablação/efeitos adversos , Eletroporação , Recidiva Local de Neoplasia/epidemiologia , Neoplasias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Técnicas de Ablação/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Seguimentos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Cuidados Intraoperatórios/métodos , Margens de Excisão , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos
2.
J Surg Res ; 246: 284-291, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31622885

RESUMO

BACKGROUND: Platelet-rich plasma (PRP) improves the healing of refractory wounds, and its application is receiving more attention in the field of wound repair. However, when a patient's condition is very poor, it may be difficult to provide whole blood to harvest autologous PRP. METHODS: We evaluated the efficacy and safety of allogeneic PRP in the field of chronic refractory wound repair. Sixty patients (39 males and 21 females, 57 ± 10 y old) with chronic wounds were enrolled in this prospective, randomized, single-center study during January 2014 to January 2018. Their wounds were treated by standard care. The patients with chronic refractory wounds were divided into allogeneic PRP treatment and control groups on the basis of the presence or absence of allogeneic PRP in wounds after debridement, respectively. Allogeneic PRP was prepared by collecting whole blood from healthy individuals and two-step centrifugation. Clinical effects were evaluated by visually observing wound conditions and objectively assessing wound surfaces. RESULTS: After 30 d of treatment, the allogeneic PRP-treated group showed bright red granulation that bled easily with reduced inflammatory exudation. No rejection reactions were observed. The rate of chronic wound healing was much faster in the allogeneic PRP-treated group than that in the control group. CONCLUSIONS: The present study shows that combined treatment of chronic wounds by standard care and allogeneic PRP significantly shortens healing time, suggesting that allogeneic PRP is an effective, safe adjuvant treatment for chronic wounds.


Assuntos
Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Pele/lesões , Cicatrização , Adulto , Idoso , Doença Crônica/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do Tratamento
3.
Semin Oncol ; 46(6): 414-420, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31784040

RESUMO

Session IV of the Second International Colloquium on Cardio-Oncology held in Kraków, focused on the cardiovascular risks of using hormone replacement therapy in breast cancer and androgen deprivation therapy in prostate cancer and continued the theme from Session 3 with a discussion of risk reduction strategies. The discussion then moved to an overview of modern radiation therapy and evolving mechanisms of cardioprotection. The risks and late cardiotoxic effects that must be considered in patients treated prior to the "modern era" were enumerated stressing the importance of long term follow-up of this population.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias/complicações , Neoplasias/terapia , Radioterapia/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Humanos , Neoplasias/mortalidade , Radioterapia/métodos , Fatores de Risco
4.
Anticancer Res ; 39(11): 6217-6222, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704850

RESUMO

BACKGROUND/AIM: Elderly cancer patients are more prevalent and require special attention. This study focused on the outcome of elderly (≥65 years) rectal cancer patients treated with tri-modality therapy. PATIENTS AND METHODS: A total of 105 patients receiving neoadjuvant radio-chemotherapy and resection for locally advanced rectal cancers were retrospectively evaluated. Nine characteristics were analyzed for loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) including tumor location, gender, age, performance status, radiotherapy technique, primary tumor/lymph node categories, downstaging and histological grading. RESULTS: The 5-year rates of LRC, MFS and OS were 91%, 78% and 87%, respectively. Radio-chemotherapy was not completed in 12 patients (11%) due to toxicity; 18 patients (17%) experienced grade 3 toxicities. A total of 29 patients (28%) had surgical complications. On multivariate analyses, MFS was significantly associated with downstaging (p=0.003) and OS with lower histological grade (p=0.013). CONCLUSION: Tri-modality therapy resulted in promising outcomes and was tolerated reasonably well by elderly patients. Prognostic factors were identified that may help personalize future treatment.


Assuntos
Neoplasias Retais/terapia , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Capecitabina/administração & dosagem , Quimiorradioterapia Adjuvante/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Fluoruracila/administração & dosagem , Humanos , Avaliação de Estado de Karnofsky , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Oxaliplatina/administração & dosagem , Complicações Pós-Operatórias , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento
5.
Dermatol Surg ; 45(11): 1401-1405, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31658188

RESUMO

BACKGROUND: Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE: The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS: Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS: No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION: The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.


Assuntos
Antibacterianos/efeitos adversos , Doxiciclina/efeitos adversos , Terapia de Luz Pulsada Intensa/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Rosácea/terapia , Administração Cutânea , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Doxiciclina/administração & dosagem , Feminino , Humanos , Terapia de Luz Pulsada Intensa/instrumentação , Terapia de Luz Pulsada Intensa/métodos , Lasers de Corante/efeitos adversos , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/etiologia , Estudos Retrospectivos , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Resultado do Tratamento , Adulto Jovem
6.
Cardiol Clin ; 37(4): 505-523, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587791

RESUMO

Cardiovascular effects of cancer therapies are of concern. Prediction, diagnosis, and management of cardiotoxicity is a challenge. Cardiovascular biomarkers are being studied in relationship to cancer therapy, showing promise in detection and prevention of cardiotoxicity. We summarize the use of biomarkers in cardio-oncology and presents recommendations for their use. Troponins and natriuretic peptides are the most commonly used biomarkers. High-quality evidence supporting their use is lacking. Biomarkers can be incorporated into a detection strategy for cardiotoxicity. Large, well-powered studies are needed to delineate care strategies using biomarkers in the prediction and management of the cardiovascular effects of cancer therapy.


Assuntos
Biomarcadores Tumorais/metabolismo , Doenças Cardiovasculares , Neoplasias , Medição de Risco/métodos , Cardiotoxicidade , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Terapia Combinada/efeitos adversos , Saúde Global , Humanos , Incidência , Neoplasias/complicações , Neoplasias/metabolismo , Neoplasias/terapia
7.
Cardiol Clin ; 37(4): 545-557, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587794

RESUMO

Cardio-oncology is rapidly expanding as part of cancer therapy in both the acute phase and later stages after treatment. The shifting paradigm of cancer becoming a chronic disease requires long-term follow-up for ongoing cardiac toxicity. As more cancer patients enter the survivorship phase, there needs to be identification of those at risk and strategies for how best to monitor long-term cancer therapy-related cardiac disease. This article serves as a template decide if a cardio-oncology program should be started and expanded as a center of excellence for the discipline as well as to help in implementing and financially sustaining a program.


Assuntos
Cardiologia/organização & administração , Doenças Cardiovasculares/terapia , Assistência à Saúde/economia , Oncologia/organização & administração , Neoplasias/terapia , Garantia da Qualidade dos Cuidados de Saúde , Doenças Cardiovasculares/etiologia , Terapia Combinada/efeitos adversos , Humanos , Neoplasias/complicações
8.
Exp Oncol ; 41(3): 254-257, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31569931

RESUMO

The potential of one of the adsorption methods, enterosorption (ES), using the new generation of carbon adsorbents to correct the negative manifestations of tumor-host interaction in the framework of paraneoplastic syndrome (PNS) as well as systemic toxicity of chemo- and radiation therapy, is discussed. The ES influence on the development of PNS was demonstrated in C57/BL6 mice with transplanted Lewis lung carcinoma. Two-week administration of carbon enterosorbents resulted in a significant suppression of metastasis and correction of tumor-related anemia, activation of granulocytic line in the bone marrow with nearly 3-fold enhancement of its mitotic activity. ES exerted a positive influence on the structural-morphologic indexes and regenerative potential of kidneys and liver, mitigated manifestations of oxidative stress, decreased the level of endogenous intoxication, increased resistance of erythrocyte membranes and decreased ligand loading of blood plasma transport proteins. The effect of ES on anticancer activity and toxic reactions of cisplatin (CP) was evaluated in Guerin carcinoma-bearing rats. ES reduced significantly creatinine and other kidney biochemical indexes elevated in the blood plasma of rats after CP treatment. ES attenuated dystrophic changes in the histological structure of internal organs (kidney, liver, spleen), caused by tumor growth and significantly aggravated under the influence of CP. Such changes were specially traced in the kidneys and well reflect the nephroprotective potential of ES. In rats irradiated with X-ray in sublethal dose, highly activated granulated carbonic enterosorbents facilitated the restoration of white blood cells and lymphocyte count. The results obtained confirm the insights of academician R.E. Kavetsky predicting the future of adsorptive detoxification with activated carbons in the treatment of cancer patients.


Assuntos
Enteroadsorção , Neoplasias/terapia , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Modelos Animais de Doenças , Enteroadsorção/efeitos adversos , Enteroadsorção/métodos , Humanos , Masculino , Camundongos , Neoplasias/complicações , Neoplasias/diagnóstico , Síndromes Paraneoplásicas/terapia , Resultado do Tratamento
9.
Immunol Allergy Clin North Am ; 39(4): 561-572, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563189

RESUMO

Advances in the management of pediatric asthma, including biologics, offer practitioners the ability to tailor therapies to individual patients. However, asthma treatment guidelines have not kept up with current studies. This review explores the current literature incorporating the use of phenotyping in pediatric patients with asthma to provide precision therapy. Biomarkers can be used to more accurately predict the development of asthma, identify features that may be associated with difficult-to-control or severe asthma, and forecast response to therapies. Biomarkers and other phenotypic data can also be helpful in patients with uncontrolled, severe asthma in the selection of a biologic therapy.


Assuntos
Asma/diagnóstico , Fenótipo , Fatores Etários , Asma/etiologia , Asma/terapia , Biomarcadores , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Prognóstico , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
10.
Hematol Oncol ; 37(5): 609-616, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31523837

RESUMO

Anti-cancer treatment in children can deteriorate gonadal function and affect future fertility. We analyzed the hormonal markers of gonadal function in adolescent leukemia survivors, treated in childhood with different levels of aggressiveness. We analyzed hormone levels in 69 adolescents and young adults, leukemia survivors stratified into standard (SR), intermediate (IR), and high (HR) risk groups, and in 80 healthy controls (38 men) at a similar age. We assessed follicular stimulating hormone (FSH), luteinizing hormone (LH), and inhibin B in the whole group, testosterone in males, and E2 and anti-Müllerian hormone (AMH) in females. Males classified into HR group presented, in comparison to control, higher levels of FSH, LH, lower inhibin B, and normal testosterone, whereas in SR and IR group, the hormonal values were comparable to the control. In females, in all risk groups, the levels of FSH, LH, E2, and inhibin B were comparable with the control, but the mean AMH levels were slightly lowered. We did not observe the effect of prophylactic cranial irradiation (12 or 18 Gy) or the time of treatment (before vs. during puberty) on hormone levels. In females, a positive correlation was found between the time interval after the end of treatment and AMH levels. Male leukemia survivors having undergone more intensive chemotherapy show the symptoms of disturbed spermatogenesis and need to be followed-up in the future. Women, irrespective of the risk group, can develop the signs of preterm ovarian insufficiency. They should be informed about the impact of the treatment on gonadal function.


Assuntos
Biomarcadores , Sobreviventes de Câncer , Hormônios Esteroides Gonadais/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Adolescente , Criança , Pré-Escolar , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Fertilidade , Seguimentos , Gônadas/metabolismo , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia
11.
In Vivo ; 33(5): 1707-1712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471428

RESUMO

BACKGROUND/AIM: Patients with tinnitus suffer not only from auditory dysfunction but also physical, mental, and social difficulties. Our aim was to investigate the outcomes of our triple-combination therapy for chronic tinnitus, which includes narrow-band noise masking, auricular acupuncture and cognitive behavioral therapy. PATIENTS AND METHODS: The tinnitus handicap inventory (THI) scores of 78 adults with chronic tinnitus who received triple-combination therapy for 12 weeks were analyzed retrospectively. RESULTS: There were 39 females and 39 males in this study. The mean age was 60.5 years [standard deviation (SD)=13.0, range=27-88 years] for all subjects. Mean pure tone average=39.5 decibel hearing level (SD=23.09). Pre-treatment mean THI score was 41.4 (SD=21.13), functional (F) subscore was 17.9 (SD=10.69), emotional (E) subscore was 10.6 (SD=6.87), and catastrophic (C) subscore was 12.9 (SD=4.85). Post-treatment THI total score was significantly lower compared to pre-treatment THI total score. Also, post-treatment subscores were significantly lower compared to pre-treatment subscores in F and C subsocres, but not in E subscore. In addition, multivariate logistic regression analysis showed that coffee and tea consumption was significantly positively associated with a reduction of THI total score. CONCLUSION: Triple-combination therapy could be helpful for chronic tinnitus patients. It seemed that coffee and tea consumption may elicit increased improvement in conjunction with combined therapy for chronic tinnitus.


Assuntos
Terapia Combinada , Zumbido/terapia , Acupuntura Auricular/métodos , Idoso , Doença Crônica , Café , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Chá , Zumbido/diagnóstico , Resultado do Tratamento
12.
Anticancer Res ; 39(9): 5077-5081, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519618

RESUMO

BACKGROUND/AIM: Patient performance scores are used widely in clinical practice to assess a patient's general condition. The aim of this study was to evaluate the prognostic role of Eastern Cooperative Oncology Group performance score (ECOG PS) before, after and its changes during chemoradiotherapy in patients with stage III non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Records of 99 patients with stage III NSCLC were evaluated. ECOG PS before, during and after chemoradiotherapy was analyzed for prognostic impact on overall (OS) and event-free (EFS) survival. RESULTS: Median OS considering the entire cohort was 20.8 months (range=15.3-26.2 months). Median OS, and 1- and 2-year survival rates were 26.4 months, 85% and 53% in patients with ECOG PS 0 versus 18.9 months, 69% and 37% in patients with ECOG PS 1 (p=0.1, log-rank test), respectively. After the first follow-up, 35% of patients presented worsening ECOG PS, while in 65% it was stable or improved. Median EFS according to ECOG PS 0, 1, 2 and 3 was 9.6, 9.0, 7.9 and 3.5 months, respectively, at the first follow-up (p=0.018, log-rank test). Deterioration of ECOG PS after chemoradiotherapy resulted in reduced OS in the subgroups with initial ECOG PS 0 and 1 (p=0.005 and p=0.001, log-rank test). CONCLUSION: ECOG PS and its changes have a strong impact on patient outcome. Deterioration of performance status was a strong negative prognostic factor for EFS and OS.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Terapia Combinada , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Quimiorradioterapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Tomografia Computadorizada por Raios X
13.
Pediatr Blood Cancer ; 66(11): e27960, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31407504

RESUMO

BACKGROUND/OBJECTIVES: Survivors of high-risk neuroblastoma (NB) are exposed to multimodality therapies early in life and confront late therapy-related toxicities. This study assessed respiratory symptoms, exercise capacity, and longitudinal changes in pulmonary function tests (PFTs) among survivors. DESIGN/METHODS: Survivors of high-risk NB followed in the long-term follow-up clinic at Memorial Sloan Kettering Cancer Center were enrolled. Symptom and physical activity questionnaires were completed. Medical records were reviewed for treatments and comorbidities. Participants completed spirometry, plethysmography, diffusion capacity of the lung for carbon monoxide, 6-minute walk tests (6MWTs), and cardiopulmonary exercise testing. Questionnaires and PFTs were repeated at least one year after enrollment. RESULTS: Sixty-two survivors participated (median age at study: 10.92 years; median age at diagnosis: 2.75 years; median time since completion of therapy: 5.29 years). Thirty-two percent had chronic respiratory symptoms. Seventy-seven percent had PFT abnormalities, mostly mild to moderate severity. Thirty-three completed 6MWTs (median, 634.3 meters); eight completed cardiopulmonary exercise tests (mean VO2 max: 63% predicted); 23 completed a second PFT revealing declines over a median 2.97 years (mean percent predicted forced vital capacity: 79.9 to 70.0; mean forced expiratory volume in 1 second: 81.6 to 69.9). Risks for abnormalities included thoracic surgery, chest radiation therapy (RT), thoracic surgery plus chest RT, and hematopoietic stem cell transplant. CONCLUSIONS: In this cohort of survivors of high-risk NB, PFT abnormalities were common but mostly mild or moderate. Maximal exercise capacity may be affected by respiratory limitations and declines in lung function may occur over time. Continued pulmonary surveillance of this at-risk population is warranted.


Assuntos
Sobreviventes de Câncer , Tolerância ao Exercício , Pulmão/fisiopatologia , Neuroblastoma/terapia , Adolescente , Sobreviventes de Câncer/estatística & dados numéricos , Criança , Terapia Combinada/efeitos adversos , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Testes de Função Respiratória , Risco , Fumar/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
14.
Anticancer Res ; 39(8): 4467-4474, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366546

RESUMO

BACKGROUND/AIM: The aim of this study was to investigate the association between lymphopenia after breast conserving therapy (BCT) and ipsilateral breast tumor recurrence (IBTR) in early breast cancer (EBC). PATIENTS AND METHODS: We examined 216 EBC patients treated with partial mastectomy followed by radiotherapy (RT), none of whom received chemotherapy. Absolute lymphocyte counts (ALCs) during the two years after RT were collected from each patient: pretreatment ALC, ALC at 3-5 months (ALC1), ALC at 9-11 months, ALC at 15-17 months, and ALC at 21-23 months. RESULTS: The 102 patients with ALC1 ≤1,479 cells/µl (defined as lymphopenia) had significantly higher 10-year IBTR rate than the 102 patients with ALC1 >1,479 cells/µl (16.2% vs. 1%, p=0.0034). The multivariate analysis showed that age, resection margins, human epidermal growth factor receptor, and lymphopenia were significant predictors of IBTR. CONCLUSION: Lymphopenia is a potential predictor for IBTR in EBC patients treated with BCT.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Linfopenia/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Linfopenia/induzido quimicamente , Linfopenia/epidemiologia , Linfopenia/patologia , Mastectomia , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos
15.
World J Gastroenterol ; 25(27): 3649-3663, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367163

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) has been revealed as the second most common cause of cancer-related deaths worldwide. The introduction of cell-based immunotherapy, including dendritic cells (DCs) and cytokine-induced killer cells (CIKs), has brought HCC patients an effective benefit. However, the efficacy and necessity of cellular immunotherapy after different interventional therapy remains to be further explored. AIM: To investigate the efficacy of cellular immunotherapy, involving DCs and CIKs, combined with different conventional treatments of HCC. METHODS: We performed a literature search on PubMed and Web of Science up to February 15, 2019. Long-term efficacy (overall survival and recurrence) and short-term adverse effects were investigated to assess the effectiveness of immunotherapy with DCs and/or CIKs. Review Manager 5.3 was used to perform the analysis. RESULTS: A total of 22 studies involving 3756 patients selected by eligibility inclusion criteria were forwarded for meta-analysis. Combined with the conventional clinical treatment, immunotherapy with DCs and/or CIKs was demonstrated to significantly improve overall survival at 6 mo [risk ratio (RR) = 1.07; 95% confidence interval (CI): 1.01-1.13, P = 0.02], 1 year (RR = 1.12; 95%CI: 1.07-1.17, P < 0.00001), 3 years (RR = 1.23; 95%CI: 1.15-1.31, P < 0.00001) and 5 years (RR = 1.26; 95%CI: 1.15-1.37, P < 0.00001). Recurrence rate was significantly reduced by cellular immunotherapy at 6 mo (RR = 0.50; 95%CI: 0.36-0.69, P < 0.0001) and 1 year (RR = 0.82; 95%CI: 0.75-0.89, P < 0.00001). Adverse effect assessment addressed that immunotherapy with DCs and/or CIKs was accepted as a safe, feasible treatment. CONCLUSION: Combination immunotherapy with DCs, CIKs and DC/CIK with various routine treatments for HCC was evidently suggested to improve patients' prognosis by increasing overall survival and reducing cancer recurrence.


Assuntos
Carcinoma Hepatocelular/terapia , Células Matadoras Induzidas por Citocinas/transplante , Células Dendríticas/transplante , Imunoterapia Adotiva/métodos , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/prevenção & controle , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/mortalidade , Ensaios Clínicos como Assunto , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Células Matadoras Induzidas por Citocinas/imunologia , Células Dendríticas/imunologia , Estudos de Viabilidade , Humanos , Imunoterapia Adotiva/efeitos adversos , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/mortalidade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/imunologia , Prognóstico , Análise de Sobrevida , Resultado do Tratamento
16.
Int J Mol Sci ; 20(17)2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31450659

RESUMO

Clinical interest in the human intestinal microbiota has increased considerably. However, an overview of clinical studies investigating the link between the human intestinal microbiota and systemic cancer therapy is lacking. This systematic review summarizes all clinical studies describing the association between baseline intestinal microbiota and systemic cancer therapy outcome as well as therapy-related changes in intestinal microbiota composition. A systematic literature search was performed and provided 23 articles. There were strong indications for a close association between the intestinal microbiota and outcome of immunotherapy. Furthermore, the development of chemotherapy-induced infectious complications seemed to be associated with the baseline microbiota profile. Both chemotherapy and immunotherapy induced drastic changes in gut microbiota composition with possible consequences for treatment efficacy. Evidence in the field of hormonal therapy was very limited. Large heterogeneity concerning study design, study population, and methods used for analysis limited comparability and generalization of results. For the future, longitudinal studies investigating the predictive ability of baseline intestinal microbiota concerning treatment outcome and complications as well as the potential use of microbiota-modulating strategies in cancer patients are required. More knowledge in this field is likely to be of clinical benefit since modulation of the microbiota might support cancer therapy in the future.


Assuntos
Microbioma Gastrointestinal , Neoplasias/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Gerenciamento Clínico , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/efeitos da radiação , Humanos , Metagenoma , Metagenômica/métodos , Neoplasias/complicações , Neoplasias/mortalidade , Prognóstico , Resultado do Tratamento
17.
Eur J Haematol ; 103(3): 152-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31270855

RESUMO

Follicular Lymphoma (FL) is an indolent lymphoma and may have various clinical courses. Worldwide, FL is the second most common non-Hodgkin lymphoma (NHL) type after diffuse large B-cell lymphoma. In this review article, the author is discussing relevant diagnostic tools, prognostic factors, and updated study results on the management of patients with newly diagnosed and relapsed/refractory FL. Controversies in the treatment, maintenance therapy, stem cell transplantation, and novel treatment approaches will be comprehensively discussed.


Assuntos
Linfoma Folicular/diagnóstico , Linfoma Folicular/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Linfoma Folicular/epidemiologia , Linfoma Folicular/etiologia , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Recidiva , Resultado do Tratamento
18.
Pain Res Manag ; 2019: 7964897, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31316682

RESUMO

Objective: Studies regarding the combination of ultrasound and transcutaneous electrical nerve stimulation (TENS) are rarely reported. In this study, we aimed to elucidate the efficacy and safety of a stimulator using low-intensity pulsed ultrasound (LIPUS) combined with TENS in patients with painful knee osteoarthritis (OA). We evaluated the effectiveness of this therapy against pain, physical function, and cartilage regeneration. Moreover, we aim to prove the superiority of the effects of LIPUS combined with TENS therapy compared with only TENS therapy. Methods: Of the 40 included patients, aged 45-85 years with painful knee OA, 20 patients received only TENS therapy and 20 patients received LIPUS combined with TENS therapy for 8 weeks (a total of more than 80 treatment sessions). We evaluated visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, MOS 36-Item Short-Form Health Survey (SF-36), and femoral articular cartilage (FAC) thickness. The evaluation was performed at three visits: visit 1 (V1, pretreatment, within 28 days after screening), visit 2 (V2, posttreatment period 1, ±3 days after treatment), and visit 3 (V3, posttreatment period 2, 21 ± 3 days after treatment). Results: We expected that LIPUS combined with TENS therapy would be superior to only TENS therapy. However, there was no significant difference between the two therapies. In the within-group comparison, both treatments (only TENS therapy and LIPUS with TENS therapy) demonstrated statistical differences from baseline values for pain and physical function outcomes. FAC thickness showed no significant differences after treatment in both groups. Conclusion: The effects of a stimulator using LIPUS with TENS on pain relief and functional improvement were not superior to the only TENS therapy. Cartilage regeneration, which was expected as an additional benefit of LIPUS, was also not significantly evident. Therefore, further investigation is warranted to determine whether the combination therapy is beneficial. This trial is registered with KCT0003883.


Assuntos
Terapia Combinada/métodos , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Terapia por Ultrassom/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Método Simples-Cego , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Ondas Ultrassônicas/efeitos adversos
19.
J Thromb Thrombolysis ; 48(2): 203-208, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214876

RESUMO

This meta-analysis was conducted to assess the safety and efficacy of sonothrombolysis along with intravenous recombinant tissue plasminogen activator, alteplase (IV rtPA), in the management of acute ischemic stroke. Electronic databases were searched under different meSH terms without the restriction of time and language. 1415 studies were analyzed and seven studies that matched the inclusion criteria were selected. Multiple safety and efficacy outcomes were extracted. Our pooled analysis demonstrated that there is no significant difference between sonothrombolysis group and control group in preventing mortality (RR 1.10 [0.81, 1.50]; p = 0.55; I2 = 0%) and intracranial hemorrhage (RR 1.11 [0.76, 1.63]; p = 0.59; i2 = 0%), however, among the efficacy outcomes; complete recanalization after 60-120 min was achieved more effectively in the sonothrombolysis group (RR 2.11 [1.48, 3.03]; p ≤ 0.0001; I2 = 0%). The rest of the efficacy outcomes like neurological improvement at 24 h (RR 1.20 [0.92, 1.57]; p = 0.18; I2 = 40%) and excellent functional outcome after 3 months (RR 1.19 [0.93, 1.52]; p = 0.17; I2 = 35%) showed no significant differences between the two groups. In subgroup analysis, we found that sonothrombolysis led to a better neurological improvement in patients who were less than 65 years of age (RR 1.20 [0.92, 1.57]; p = 0.05; I2 = 40%). Moreover, there were no significant differences in the following of the subgroups assessed: (a) microsphere or microbubble use, (b) Ultrasound frequency (2 MHz or < 2 MHz), (c) transcranial Doppler (TCD) duration (1 h or 2 h), (d) age (≤ 65 or > 65).


Assuntos
Isquemia Encefálica/terapia , Terapia Combinada/normas , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Terapia Combinada/efeitos adversos , Terapia Combinada/mortalidade , Humanos , Hemorragias Intracranianas/etiologia , Pessoa de Meia-Idade , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica/mortalidade , Terapia Trombolítica/normas , Resultado do Tratamento , Ultrassonografia
20.
Int J Med Sci ; 16(5): 660-664, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217733

RESUMO

Objective: To investigate the safety and efficacy of the combination therapy of anterior stromal puncture (ASP) with bandage contact lens for bullous keratopathy (BK). Methods: Twelve cases (12 eyes) with vision acuity no better than light perception were treated with ASP surgery and bandage contact lens. 200 points punctures were made through the corneal epithelium and Bowman's layer vertically, using fine needles. A soft bandage contact lens was applied immediately and removed 2 weeks later. The severity of irrigating symptoms including pain, photophobia and tearing was graded and calculated before treatment and 1, 2, 4, 12 weeks after the surgery, slit-lamp microscope examination was used to quantify the time for corneal epithelial blisters disappearing, optical coherence tomography (OCT) was used to monitor the central corneal thickness. Results: No cornea infection was observed during the following up period. The average grade scores of the irrigating symptoms was 8.3 ± 2.1 before surgery, while it was reduced to 4.8 ±1.9 two weeks after the surgery (p=0.0003). Slit-lamp microscope examination showed that corneal edema relieved obviously after the operation, the average time for epithelial blisters disappearing was 15.6 ± 4.0 days. The average central corneal thickness of the eyes was 999.3 ±278.0 µm before the treatment, while it was 805.1 ± 145.0 µm four weeks after the treatment, with a statistically significant difference (p=0.043). Conclusions: ASP with bandage contact lens is an effective and safe treatment for patients with BK and low vision that not suitable for corneal transplantation.


Assuntos
Bandagens , Lentes de Contato , Edema da Córnea/terapia , Punções/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Córnea/patologia , Córnea/cirurgia , Edema da Córnea/diagnóstico , Edema da Córnea/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Acuidade Visual
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