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1.
Anticancer Res ; 40(2): 1175-1181, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014971

RESUMO

BACKGROUND/AIM: This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT). PATIENTS AND METHODS: A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed. RESULTS: The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the non-sarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome. CONCLUSION: Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.


Assuntos
Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Sarcopenia/etiologia , Sarcopenia/mortalidade , Idoso , Composição Corporal , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sarcopenia/diagnóstico , Análise de Sobrevida , Resultado do Tratamento
2.
Oncology ; 98(3): 154-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995803

RESUMO

INTRODUCTION: Nasopharyngeal cancer (NPC) is a common malignancy in Southeast Asia with a high mortality rate. Previous studies have shown that the patient survival rate is <80% worldwide. At the Dharmais Cancer Hospital, NPC is the first of the top 10 diseases with the highest rate of stage III cancer progression. OBJECTIVE: This study aims to determine the 5-year survival rate of patients with NPC based on tumor response and their prognostic factors after receiving neoadjuvant chemotherapy, followed by chemoradiation. METHODS: The records of 261 patients between January 2009 and December 2013 were retrospectively analyzed. All patients with NPC who received neoadjuvant chemotherapy, followed by chemoradiation, at the Dharmais Cancer Hospital from 2009 to 2013 were identified. Patients with metastasis were excluded. The primary endpoint of this study was overall survival, which was defined as the time from the date of treatment to the date of death. The survival curve was analyzed using the Kaplan-Meier method. The Cox proportional hazard model was used for the multivariate analysis of prognostic factors. RESULTS: The tumor response rates for patients with complete response (CR), partial response (PR), and progressive disease (PD) were 33.7, 45.2, and 21.2%, respectively. The 5-year overall survival rate was 38.6%. The 5-year survival rates based on tumor response among CR, PR, and PD patients were 71.0, 30.4, and 10.6%, respectively. The significant independent prognostic factors were tumor response, educational background, job, alcohol consumption, clinical stage, and prompt treatment. CONCLUSION: The survival probability of patients with NPC receiving neoadjuvant chemotherapy, followed by chemoradiation, was higher in the CR group than in the PR and PD groups. This confirms that early detection can improve the patient's survival. Long-term follow-up is required to determine the factors influencing tumor response in NPC.


Assuntos
Quimiorradioterapia Adjuvante , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/terapia , Terapia Neoadjuvante , Adulto , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/mortalidade , Progressão da Doença , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/mortalidade , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/patologia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Indução de Remissão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
3.
Oncology ; 98(3): 168-173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31918425

RESUMO

BACKGROUND: There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. OBJECTIVE: This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients' outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). METHODS: This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: <4 weeks, 4-7 weeks, or ≥8 weeks. Outcomes were assessed using Kaplan-Meier curves, and the variables were compared using log-rank statistics. RESULTS: The 5-year OS rate was 89.6% and the 5-year DFS rate was 74%. OS and DFS were not significantly different when stratified according to timing of surgery; however, the trends of OS and DFS were poor when surgery was delayed for ≥8 weeks. Median OS and median DFS have not yet been reached. Of the 17% of patients that had surgery after ≥8 weeks, 12.9% had pathological complete response (pCR), while among those that received surgery 4-7 weeks and <4 weeks after neoadjuvant chemotherapy, 26% and 21% had pCR, respectively (p = 0.02). ER+/HER-2+ patients had a statistically significant decrease in pCR if surgery was performed after ≥8 weeks. CONCLUSION: Our patients showed improved pCR if surgery was performed within 8 weeks, especially for ER+/HER-2+ patients. All patients had better OS and DFS trends if surgery was performed between 4 and 7 weeks after neoadjuvant chemotherapy.


Assuntos
Neoplasias da Mama/terapia , Mastectomia , Terapia Neoadjuvante , Tempo para o Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Mastectomia/efeitos adversos , Mastectomia/mortalidade , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Estadiamento de Neoplasias , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
4.
Int J Radiat Oncol Biol Phys ; 106(1): 124-133, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494181

RESUMO

PURPOSE: Preoperative therapy in borderline resectable pancreatic cancer (BRPC) is intended to increase R0 resection rates. An optimal approach in BRPC is yet to be defined. METHODS AND MATERIALS: Patients with BRPC, confirmed adenocarcinoma, performance status ≤1, and adequate organ function enrolled in a single-institution, phase 2 trial. Patients received FOLFIRINOX × 6 cycles, then radiation therapy (50 Gy in 25 fractions) concurrent with fixed-dose rate gemcitabine (1 g/m2 over 100 minutes) followed by 2 additional gemcitabine infusions. Computed tomography scans were performed at 2-month intervals during treatment. Patients without distant disease were offered surgical exploration. The primary objective was R0 resection rate with an alternate hypothesis of 55%. Secondary objectives included median progression-free survival (PFS), median overall survival (OS), response rate, and safety. The trial registration number is NCT01661088. RESULTS: Twenty-five patients with median age of 60 years (range, 47-77 years) enrolled from November 2011 through January 2017. Twenty-one (84%) completed FOLFIRINOX and 19 (76%) completed all protocol therapy. Treatment-related grade 3 to 4 toxicities included neutropenia (40%), nausea and vomiting (28%), diarrhea (16%), and fatigue (12%). Eighteen patients (72%) underwent laparotomy, 13 (52%) were resected (all R0). The median PFS and OS in 25 patients were 13.1 months (95% confidence interval [CI], 7.3-24.7) and 24.4 months (95% CI, 12.6-40.0), respectively. For resected patients, median PFS was 21.6 months (95% CI, 8.2-37.1) and OS was 37.1 months (95% CI, 15.4-not reached). CONCLUSIONS: Neoadjuvant therapy with FOLFIRINOX, followed by intensity modulated radiation therapy concurrent with fixed-dose-rate gemcitabine in BRPC is feasible and tolerated. Although the alternate hypothesis was not met, the OS of the resected cohort was favorable.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Desoxicitidina/análogos & derivados , Terapia Neoadjuvante/métodos , Neoplasias Pancreáticas/terapia , Radioterapia de Intensidade Modulada/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Antígeno CA-19-9/metabolismo , Quimiorradioterapia/métodos , Desoxicitidina/administração & dosagem , Fracionamento da Dose de Radiação , Estudos de Viabilidade , Feminino , Fluoruracila/administração & dosagem , Humanos , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Neutropenia/induzido quimicamente , Oxaliplatina/administração & dosagem , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Intervalo Livre de Progressão , Radioterapia de Intensidade Modulada/efeitos adversos
5.
Int J Cancer ; 146(2): 413-423, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31246277

RESUMO

In the OS2006 study, patients younger than 18 years were treated with a methotrexate-based regimen (MTX), patients older than 25 years with a doxorubicin-cisplatin-ifosfamide-based regimen (API-AI), whereas patients aged 18-25 years received either API-AI or MTX. We herein report the prespecified subgroup analysis of the outcome of 106 patients treated with API-AI. Preoperative chemotherapy combined three doxorubicin-ifosfamide-cisplatin (API) and two doxorubicin-ifosfamide (AI) courses. Postoperative chemotherapy was assigned by risk group: localised patients with a good histological response (<10% viable cells) received two AI and two cisplatin-ifosfamide (PI) courses; patients with synchronous metastases, poor histological response or unresectable primary received five cycles of etoposide-ifosfamide (EI). Of the 106 patients, 61 were randomised to receive or not zoledronate. Median age was 30 years (range 18-67), 66 (62%) patients were >25 years. The primary tumours were axial in 28 patients (26%), and 28 (26%) presented with metastases. Ninety-six patients (91%) had surgery, conservative in 82 (85%); 36 patients (38%, 95% CI 28-48%) were good responders. Toxicity was manageable, with no significant difference in severe acute toxicity between patients aged >25 years and those younger. With a median follow-up of 4.8 years, the 5-year event-free survival and overall survival rates were 46% (95% CI 36-56) and 57% (95% CI 47-67), respectively. The primary tumour size and initial metastases correlated with a higher risk of event. In these 106 osteosarcoma adult patients, API-AI proved feasible with no excess of toxicity, and favourable activity despite poor-prognosis factors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Ósseas/terapia , Osteossarcoma/terapia , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Esquema de Medicação , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , França/epidemiologia , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Prognóstico , Taxa de Sobrevida , Adulto Jovem , Ácido Zoledrônico/administração & dosagem , Ácido Zoledrônico/efeitos adversos
6.
J Surg Res ; 245: 234-243, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421368

RESUMO

BACKGROUND: Conversion therapy is intended to allow achieving R0 resection after chemotherapy for tumors initially considered unresectable or partially resectable. Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) is the current conversion therapy for gastric cancer (GC) patients with peritoneal metastasis. This meta-analysis evaluated the effectiveness and safety of NIPS-combined surgery for GC patients with peritoneal metastasis. METHODS: Standard methods were used to select and analyze studies that included GC patients with peritoneal metastasis assigned to two groups, either NIPS-combined surgery or a NIPS-only control. Publications were retrieved from PubMed, EMBASE, Medline, and the Cochrane Central Register. Overall survival, conversion therapy success and R0 resection rates, and adverse events were analyzed using Stata 11.0. RESULTS: Eight of the 14 studies that were evaluated after screening the titles and abstracts of 327 retrieved publications met the selection criteria. The eight retrospective studies included 373 patients with GC and peritoneal metastasis included 265 with NIPS-combined surgery and 109 with NIPS only. Survival was significantly better with NIPS-combined surgery than with NIPS only (hazard ratio = 0.440, 95% confidence interval [CI]: 0.274-0.704; P = 0.0001; odds ratio = 1.960; 95% CI: 1.247-3.083; P = 0.004). Subgroup analysis revealed significantly better survival with S-1 Joint intravenous paclitaxel and intraperitoneal paclitaxel compared with other NIPS regimens. NIPS regimens had a higher conversion rate (effect size [ES] = 0.656; 95% CI: 0.495-0.817; P < 0.05), higher percentage of patients with R0 surgery (ES = 0.633; 95% CI: 0.568-0.699; P < 0.05), less severe adverse reactions to chemotherapy (ES = 0.030; 95% CI: 0.020-0.040; P < 0.05), and fewer postoperative complications (ES = 0.040; 95% CI: 0.020-0.050; P < 0.05). CONCLUSIONS: NIPS-combined surgical treatment was effective and safe for treating GC with peritoneal metastasis. Higher quality trials, better patient selection, and multicenter randomized controlled trials are needed to support standard treatment guidelines.


Assuntos
Antineoplásicos/administração & dosagem , Gastrectomia , Terapia Neoadjuvante/métodos , Neoplasias Peritoneais/terapia , Neoplasias Gástricas/terapia , Humanos , Infusões Parenterais , Terapia Neoadjuvante/efeitos adversos , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Análise de Sobrevida , Resultado do Tratamento
7.
Anticancer Res ; 39(12): 6957-6963, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810967

RESUMO

BACKGROUND/AIM: The aim of this study was to delineate clinical criteria to safely select elderly patients who can benefit from adding oxaliplatin to 5-fluoruracil-based neo-adjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) management. PATIENTS AND METHODS: This is a single-institutional case-control study on LARC patients who received intensified neo-adjuvant CRT, between January 2007 and December 2014. Data concerning patient characteristics, treatment details and adverse events were reviewed and analyzed in two settings: young patients (<65 years) and elderly (≥65 years). A binary logistic model was applied to analyze the potential interaction between clinical variables and severe toxicity risk. RESULTS: In total, 100 consecutive LARC patients were included. Mean age was 63.6 years and 55% (n=55) of the patients had adult comorbidity evaluation-27 (ACE-27) score ≥1. Most cancers (81%) were lymph node positive at diagnosis. Overall, ≥5 cycles of oxaliplatin were administered to 92 patients (92%). Only 17 patients (17%) reported grade ≥3 toxicity. The elderly group did not experience significantly higher severe toxicity than the young group. ACE-27 score ≥1 was the only variable independently associated with a higher severe toxicity. The 5-year overal survival (OS) rates were 64.1% and 89.2% in the elderly and young cohort, respectively. CONCLUSION: Elderly LARC patients can be safely treated with intensified neo-adjuvant CRT.


Assuntos
Quimiorradioterapia/métodos , Oxaliplatina/uso terapêutico , Neoplasias Retais/terapia , Adulto , Idoso , Estudos de Casos e Controles , Quimiorradioterapia/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Oxaliplatina/efeitos adversos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
8.
Health Qual Life Outcomes ; 17(1): 170, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703704

RESUMO

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyze major complication rates and different aspects of health-related quality of life (HRQoL) in extremity soft tissue sarcoma (STS) patients treated with or without radio (chemo) therapy and surgery. METHODS: We performed a retrospective analysis of all patients who underwent Extremity STS excision from 2004 to 2014 (182 patients included). Patients' data were collected from patients' records. HRQoL was assessed by using EORTC QLQ-C30. RESULTS: A total of 182 patients underwent sarcoma resection. After neoadjuvant radiochemotherapy (RCT), the major-complication rate amounted to 28% (vs. 7%, no radiotherapy, p <  0.001). Major-complication rates after adjuvant radiotherapy (RT) occurred in 8% (vs. 7%, no radiotherapy, p = 0.265). Comparison QoL scores between treating with neoadjuvant RCT or without RT revealed significant worse scores with neoadjuvant RCT. Further stratification of disease control of these patients showed significant reduced scores in the group of disease-free patients with neoadjuvant RCT compared to irradiated disease-free patients. DISCUSSION: To date, there have only been a few investigations of QoL in STS. Retrospective study on quality of life have limitations, like a lack of baseline evaluation of QoL. Patient candidated to radiation therapy could have had worse QoL baseline due to more advanced disease. Disease status of the patients who answered the questionnaires could have been an influence of QoL and we could show reduced scores in the group of disease-free patients with neoadjuvant RCT, but not for the patients with recurrence or metastasis, so it is very hard to discriminate whether radiation therapy could really have an impact or not. CONCLUSION: This study might assist in further improving the understanding of QoL in STS patients and may animate for prospective studies examining the oncological therapies impact on HRQoL.


Assuntos
Terapia Neoadjuvante/efeitos adversos , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Sarcoma/terapia , Adulto , Idoso , Estudos de Casos e Controles , Extremidades , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/psicologia , Radioterapia Adjuvante/psicologia , Estudos Retrospectivos , Inquéritos e Questionários
9.
Anticancer Res ; 39(11): 5953-5962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704820

RESUMO

BACKGROUND/AIM: The presence of ascites in ovarian cancer patients is considered a negative prognostic factor. The underlying mechanisms are not clearly understood. MATERIALS AND METHODS: The amount of ascites was evaluated, preferably, using diffusion-weighted MRI at primary diagnosis in a retrospective cohort of 214 women with ovarian cancer, in an ordinal manner (amount of ascites: none, limited, moderate, abundant). In a prospective cohort comprising 45 women with ovarian cancer, IL-10 (interleukin), VEGF (vascular endothelial growth factor), TGF-ß (transforming growth factor) and CCL-2 [chemokine (C-C) motif ligand 2] were measured at diagnosis (and at interval debulking, when available). RESULTS: Gradually increasing amounts of ascites were correlated significantly, even after correction for FIGO stage, with reduced survival (p<0.0001) and stronger immunosuppression (IL10 and VEGF). Neoadjuvant chemotherapy reduced immunosuppression, which was observed as a reduction in CCL-2, IL-10 and VEGF. CONCLUSION: The amount of ascites is an independent predictor of survival and correlates with increased immunosuppression.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ascite/mortalidade , Imunossupressão/mortalidade , Terapia Neoadjuvante/efeitos adversos , Neoplasias Ovarianas/mortalidade , Adenocarcinoma de Células Claras/tratamento farmacológico , Adenocarcinoma de Células Claras/imunologia , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/imunologia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Ascite/patologia , Cistadenocarcinoma Seroso/tratamento farmacológico , Cistadenocarcinoma Seroso/imunologia , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/imunologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
10.
Plast Reconstr Surg ; 144(5): 732e-742e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688746

RESUMO

BACKGROUND: Neoadjuvant chemotherapy is offered to many patients with breast cancer. In patients undergoing mastectomy and immediate breast reconstruction, there is concern that this treatment could increase postoperative complications. The authors characterize which patients are at a higher risk of experiencing a postoperative complication, and assess the impact of postoperative complications on timing of radiation treatment. METHODS: A retrospective review was performed on patients who underwent neoadjuvant chemotherapy with mastectomy and immediate breast reconstruction using tissue expanders. Multivariable binomial logistic regression analysis was used to identify risk factors for experiencing a postoperative complication. Independent samples t tests were used to compare means for neoadjuvant chemotherapy timing and time to commencement of radiation therapy between patients with and without complications. RESULTS: A total of 128 patients were identified. Patients that experienced a complication had a statistically significant difference in time to commencement of radiation therapy (p = 0.021) and an elevated body mass index (p = 0.018) compared with patients who experienced no complication; there was no difference in timing interval of neoadjuvant chemotherapy (p = 0.692). Logistic regression showed an associate between body mass index and postoperative complication (OR, 1.09; 95 percent CI, 1.018 to 1.167; p = 0.013). CONCLUSIONS: Postoperative complications delay the commencement of radiation therapy in patients who received neoadjuvant chemotherapy and undergo mastectomy with immediate breast reconstruction. The period from the last dose of neoadjuvant chemotherapy was equivalent between those that experienced postoperative complications and those that did not. Patients with a higher body mass index are more likely to experience postoperative complications, and this should be considered when offering tissue expanders to obese patients who have received neoadjuvant chemotherapy and require adjuvant radiation treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Terapia Neoadjuvante/métodos , Centros Médicos Acadêmicos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Modelos Logísticos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Texas , Fatores de Tempo , Resultado do Tratamento
11.
Am Surg ; 85(11): 1276-1280, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775971

RESUMO

The use of neoadjuvant chemoradiation therapy in patients with pancreatic adenocarcinoma is emerging as an acceptable therapy option. The effects of neoadjuvant therapy on 30 days' outcomes in patients with pancreatic cancer are not well defined in the literature. NSQIP (2009-2012) was used. Only patients with a diagnosis of pancreatic cancer and those who underwent a Whipple were included in the analysis. Patient who underwent neoadjuvant chemoradiation therapy were compared with those who did not receive therapy. Main outcome measures were as follows: complications, ≥2 units of blood transfusions, length of stay, readmission rates, return to the operating room, and 30-day mortality. A total of 1445 patients (395: neoadjuvant chemoradiation and 1050: no neoadjuvant therapy) were identified. The mean age was 67 ± 12 years, and 51 per cent of the patients were male. Neoadjuvant chemoradiation therapy was associated with increase in readmission rates (18% vs 12.2%, P 0.02), unanticipated return to the operating room (2.3% vs 1.1%, P 0.03) with no difference in mortality rates. Neoadjuvant chemoradiation therapy is associated with increase in inhospital complications. These differences in outcomes may be explained by the more advance stage of pancreatic cancer in these subsets of patients. Resource utilization and preoperative rehabilitation are of utmost significance to overcome this rise in complications associated with neoadjuvant chemoradiation therapy.


Assuntos
Quimiorradioterapia Adjuvante/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Neoplasias Pancreáticas/terapia , Pancreaticoduodenectomia , Idoso , Quimiorradioterapia Adjuvante/métodos , Feminino , Humanos , Masculino , Método de Monte Carlo , Duração da Cirurgia , Análise de Regressão , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
12.
Nat Med ; 25(11): 1706-1714, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31686036

RESUMO

Antibodies targeting PD-1 or its ligand 1 PD-L1 such as atezolizumab, have great efficacy in a proportion of metastatic urothelial cancers1,2. Biomarkers may facilitate identification of these responding tumors3. Neoadjuvant use of these agents is associated with pathological complete response in a spectrum of tumors, including urothelial cancer4-7. Sequential tissue sampling from these studies allowed for detailed on-treatment biomarker analysis. Here, we present a single-arm phase 2 study, investigating two cycles of atezolizumab before cystectomy in 95 patients with muscle-invasive urothelial cancer (ClinicalTrials.gov identifier: NCT02662309). Pathological complete response was the primary endpoint. Secondary endpoints focused on safety, relapse-free survival and biomarker analysis. The pathological complete response rate was 31% (95% confidence interval: 21-41%), achieving the primary efficacy endpoint. Baseline biomarkers showed that the presence of preexisting activated T cells was more prominent than expected and correlated with outcome. Other established biomarkers, such as tumor mutational burden, did not predict outcome, differentiating this from the metastatic setting. Dynamic changes to gene expression signatures and protein biomarkers occurred with therapy, whereas changes in DNA alterations with treatment were uncommon. Responding tumors showed predominant expression of genes related to tissue repair after treatment, making tumor biomarker interpretation challenging in this group. Stromal factors such as transforming growth factor-ß and fibroblast activation protein were linked to resistance, as was high expression of cell cycle gene signatures after treatment.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Biomarcadores Tumorais/genética , Carcinoma de Células de Transição/tratamento farmacológico , Neoplasias Urológicas/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Carcinoma de Células de Transição/genética , Carcinoma de Células de Transição/patologia , Reparo do DNA/efeitos dos fármacos , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Transcriptoma/genética , Fator de Crescimento Transformador beta/genética , Neoplasias Urológicas/genética , Neoplasias Urológicas/imunologia , Neoplasias Urológicas/patologia , Urotélio/efeitos dos fármacos , Urotélio/patologia
13.
Surgery ; 166(6): 1041-1047, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31607486

RESUMO

BACKGROUND: Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies, but this association has not been established in esophageal cancer. We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer. METHODS: We included 165 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and postneoadjuvant chemotherapy psoas muscle indices were evaluated for associations with neoadjuvant chemotherapy response and neoadjuvant chemotherapy -related adverse events and postoperative complications, in addition to survival. Psoas muscle index cutoffs were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. RESULTS: Psoas muscle index decreased after neoadjuvant chemotherapy (from 7.17 to 6.96 cm2/m2; P = .0008), and specifically in men (from 7.45 to 7.23 cm2/m2; P = .0001) but not in women (from 5.21 to 5.17 cm2/m2; P = .810). Preneoadjuvant chemotherapy psoas muscle index (low versus high) was associated with neoadjuvant chemotherapy response (response rate: 65.1% vs 80.3%; P = .0494) and neoadjuvant chemotherapy-related adverse events (neutropenia: 93.0% vs 78.7%; P = .0337; febrile neutropenia: 53.5% vs 34.3%; P = .0278; hyponatremia: 51.2% vs 31.2%; P = .0190). Post-neoadjuvant chemotherapy psoas muscle index correlated with postoperative rate of complications (56.9% vs 33.3%; P = .0046), especially pneumonia (31.4% vs 9.7% P = .0008). Psoas muscle index was not associated with survival. CONCLUSION: Cross sectional measures of sarcopenia before and after neoadjuvant chemotherapy could predict tumor response, neoadjuvant chemotherapy -related adverse events, and postoperative complications in multidisciplinary treatments for esophageal cancer.


Assuntos
Neoplasias Esofágicas/terapia , Esofagectomia/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico , Fatores Etários , Idoso , Antineoplásicos/efeitos adversos , Intervalo Livre de Doença , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Prognóstico , Músculos Psoas/efeitos dos fármacos , Músculos Psoas/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
14.
Zhonghua Fu Chan Ke Za Zhi ; 54(9): 588-594, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550774

RESUMO

Objective: To investigate the efficacy and side effect of paclitaxel liposome for neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer. Methods: This study were included 265 cervical cancer patients staging Ⅰb2 and Ⅱa2 who underwent paclitaxel-platinum NACT followed by radical surgery from June 2008 to December 2016 in the Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. All patients were classified into two groups with 106 patients in paclitaxel liposome group and 159 patients in traditional paclitaxel group. The difference in clinicopathologic characteristics, efficacy and side effect were analyzed retrospectively between the two groups. Results: (1) Clinicopathologic characteristics: there were no significant difference in clinicopathologic characteristics between the two groups, including age, body mass index, clinical stage, pathological histology, cycles of NACT, combined platinum regimen, lymph-vascular space invasion, lymph node metastasis, deep stromal invasion, and postoperative adjuvant therapy (all P>0.05). (2) Efficacy: after NACT, the overall response occurred in 90 (15 complete response plus 75 partial response) of 106 cases in the paclitaxel liposome group versus 131 (21 complete response plus 110 partial response) of 159 cases in the traditional paclitaxel group without statistical significance (84.9% vs 82.4%; χ(2)=0.291, P=0.590). A total of 248 patients received surgery after NACT and were evaluable in survival. The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of these patients was 85.1% and 88.2%. The 5-year RFS rate in the paclitaxel liposome group was 85.9% compared with 85.2% in the traditional paclitaxel group, while the corresponding 5-year OS rate was 88.5% and 88.7%, respectively. There was no statistically significant difference in efficacy between the two groups (P=0.968, P=0.797). (3) Side effect: the incidence of allergic reaction between the paclitaxel liposome group and the traditional paclitaxel group was 0 versus 1.9% (3/159) without statistical significance (P=0.277). But the incidence of neurotoxicity in the paclitaxel liposome group significantly decreased compared with the traditional paclitaxel group (6.6% vs 15.7%, P<0.05), as well as the incidence of alopecia (67.9% vs 79.2%, P<0.05) and myalgia (17.9% vs 28.9%, P<0.05). However, significant differences were not found in terms of hematological toxicity, gastrointestinal reaction, and hepatic function damage (P>0.05). Conclusion: In paclitaxel-platinum NACT of local advanced cervical cancer, paclitaxel liposome can achieve similar efficacy compared with traditional paclitaxel, but paclitaxel liposome is helpful in decreasing the toxicity of neurotoxicity, alopecia and myalgia.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Quimioterapia Adjuvante/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Paclitaxel/administração & dosagem , Neoplasias do Colo do Útero/tratamento farmacológico , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Lipossomos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Paclitaxel/efeitos adversos , Paclitaxel/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
15.
Radiat Oncol ; 14(1): 166, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511012

RESUMO

BACKGROUND: Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer. METHODS: Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival. RESULTS: Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population. CONCLUSIONS: Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia/efeitos adversos , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Músculo Esquelético/patologia , Terapia Neoadjuvante/efeitos adversos , Sarcopenia/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Terapia Combinada , Estudos Transversais , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia/efeitos adversos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Prognóstico , Sarcopenia/diagnóstico por imagem , Sarcopenia/etiologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X/métodos
16.
World J Gastroenterol ; 25(33): 4850-4869, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31543678

RESUMO

Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.


Assuntos
Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Lesões por Radiação/epidemiologia , Neoplasias Retais/terapia , Carga Tumoral/efeitos da radiação , Intervalo Livre de Doença , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/efeitos da radiação , Imagem por Ressonância Magnética , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Órgãos em Risco/efeitos da radiação , Seleção de Pacientes , Cuidados Pré-Operatórios/métodos , Protectomia , Lesões por Radiação/etiologia , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
BMC Cancer ; 19(1): 884, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488084

RESUMO

BACKGROUND: Population-based studies suggest that emergency department visits and hospitalizations are common among patients receiving chemotherapy and that rates in routine practice are higher than expected from clinical trials. Chemotherapy-related toxicities are often predictable and, consequently, acute care visits may be preventable with adequate treatment planning and support between visits to the cancer centre. We will evaluate the impact of proactive telephone-based toxicity management on emergency department visits and hospitalizations in women with early stage breast cancer receiving chemotherapy. METHODS: In this pragmatic covariate constraint-based cluster randomized trial, 20 centres in Ontario, Canada are randomly allocated to either proactive telephone toxicity management (intervention) or routine care (control). The primary outcome is the cluster-level mean number of ED + H visits per patient evaluated using Ontario administrative healthcare data. Participants are all patients with early stage (I-III) breast cancer commencing adjuvant or neo-adjuvant chemotherapy at participating institutions during the intervention period. At least 25 patients at each centre participate in a patient reported outcomes sub-study involving the collection of standardized questionnaires to measure: severity of treatment toxicities, self-care, self-efficacy, quality of life, and coordination of care. Patients participating in the patient reported outcomes (PRO) sub-study are asked to provide written consent to link their PRO data to administrative data. Unit costs will be applied to each per person resource utilized, and a total cost per population and patient will be generated. An incremental cost-effectiveness analysis will be undertaken to compare the incremental costs and outcomes between the intervention and control groups from the health system perspective. DISCUSSION: This study evaluates the effectiveness of a proactive toxicity management intervention in a routine care setting. The use of administrative healthcare data to evaluate the primary outcome enables an evaluation in a real world setting and at a much larger scale than previous studies. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02485678. Registered 30 June 2015.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Monitorização Ambulatorial/métodos , Terapia Neoadjuvante/efeitos adversos , Instituições de Assistência Ambulatorial , Quimioterapia Adjuvante/efeitos adversos , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Estadiamento de Neoplasias , Enfermagem Oncológica/métodos , Ontário , Medidas de Resultados Relatados pelo Paciente , Melhoria de Qualidade , Qualidade de Vida , Tamanho da Amostra , Autocuidado , Autoeficácia , Inquéritos e Questionários , Telefone
18.
BMJ Case Rep ; 12(8)2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31409618

RESUMO

Leukemoid reaction is a paraneoplastic phenomenon associated predominantly with solid tumours. Malignancies presenting with leukemoid reaction have a grave prognosis. It is defined as persistent neutrophil count greater than 50×103 cells/µL. We report a case of leukemoid reaction in a patient with metastatic penile cancer. A 60-year-old man with partial penectomy status for squamous cell carcinoma of penis on neoadjuvant chemotherapy, presented with left fungating inguinal lymphadenopathy and total leucocyte count 96×103 cells/µL and hypercalcaemia. Leucocytealkaline phosphatase (LAP) score was excessively elevated. The patient underwent left ilioinguinal block dissection along with vastus lateralis flap for defect reconstruction. Postoperatively, the neutrophil counts and serum calcium level normalised. The patient improved clinically and was discharged.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Reação Leucemoide/induzido quimicamente , Terapia Neoadjuvante/efeitos adversos , Neoplasias Penianas/tratamento farmacológico , Humanos , Hipercalcemia/induzido quimicamente , Contagem de Leucócitos , Linfadenopatia/induzido quimicamente , Masculino , Pessoa de Meia-Idade
19.
Pancreatology ; 19(6): 850-857, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31362865

RESUMO

BACKGROUND: Pancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy. METHODS: The diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values. RESULTS: Seventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03-1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08-1.35, p = 0.001). CONCLUSIONS: Sarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.


Assuntos
Composição Corporal/efeitos dos fármacos , Terapia Neoadjuvante/efeitos adversos , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/metabolismo , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Avaliação Nutricional , Neoplasias Pancreáticas/mortalidade , Prevalência , Estudos Retrospectivos , Risco , Sarcopenia/epidemiologia , Sarcopenia/etiologia , Sarcopenia/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Anticancer Res ; 39(8): 4363-4370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366531

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the clinical impact of low tie ligation (LT) of the inferior mesenteric artery (IMA) below the left colic artery versus high tie ligation (HT) at the origin of the IMA in patients undergoing rectal cancer surgery. PATIENTS AND METHODS: Between January 2005 and December 2017, all consecutive patients who underwent rectal resection for non-metastatic cancer were retrospectively included. Patients who had LT were compared to those who had HT. RESULTS: Overall, 200 patients were identified (101 HT and 99 LT). Postoperative 30-day mortality rate was nil in both groups. There were significantly higher severe postoperative complications in HT versus LT patients (Clavien-Dindo III-IV) (18.8% vs. 9.1%, p=0.048). Median follow-up was 38.5 months and overall survival at 5 years was 91.5% and there was no difference between the two groups (90.1% vs. 92.9%; HT vs. LT p=0.640). CONCLUSION: LT ligation of IMA significantly decreased the severe postoperative complication rate without affecting recurrence-free or overall survival.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/patologia , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligadura/métodos , Excisão de Linfonodo , Masculino , Artéria Mesentérica Inferior/patologia , Artéria Mesentérica Inferior/efeitos da radiação , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia/radioterapia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/radioterapia , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia
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