RESUMO
Leptomeningeal carcinomatosis is a fatal manifestation of metastatic breast cancer. Investigation of intrathecal (IT) trastuzumab for leptomeningeal carcinomatosis is currently underway; however, there has been no consensus. We report on two cases of human epidermal growth factor receptor 2 positive (HER2+) breast cancer following IT trastuzumab for leptomeningeal carcinomatosis. The first patient was treated with weekly IT 15 mg methotrexate plus IT 50 mg trastuzumab for 7 months, followed by IT trastuzumab (50 mg > 25 mg) for 18 months. The other patient received IT trastuzumab with systemic chemotherapy (trastuzumab and/or paclitaxel) for 13 months. Good control of leptomeningeal disease was achieved with IT trastuzumab in both patients, with survival durations of 20 and 29 months, respectively. We suggest that IT trastuzumab is a promising treatment for patients with HER2+ breast cancer and leptomeningeal carcinomatosis.
Assuntos
Humanos , Neoplasias da Mama , Mama , Consenso , Tratamento Farmacológico , Injeções Espinhais , Carcinomatose Meníngea , Metotrexato , Receptores ErbBRESUMO
Leptomeningeal carcinomatosis is a fatal manifestation of metastatic breast cancer. Investigation of intrathecal (IT) trastuzumab for leptomeningeal carcinomatosis is currently underway; however, there has been no consensus. We report on two cases of human epidermal growth factor receptor 2 positive (HER2+) breast cancer following IT trastuzumab for leptomeningeal carcinomatosis. The first patient was treated with weekly IT 15 mg methotrexate plus IT 50 mg trastuzumab for 7 months, followed by IT trastuzumab (50 mg > 25 mg) for 18 months. The other patient received IT trastuzumab with systemic chemotherapy (trastuzumab and/or paclitaxel) for 13 months. Good control of leptomeningeal disease was achieved with IT trastuzumab in both patients, with survival durations of 20 and 29 months, respectively. We suggest that IT trastuzumab is a promising treatment for patients with HER2+ breast cancer and leptomeningeal carcinomatosis.
Assuntos
Humanos , Neoplasias da Mama , Mama , Consenso , Tratamento Farmacológico , Injeções Espinhais , Carcinomatose Meníngea , Metotrexato , Receptores ErbBRESUMO
PURPOSE: This study analyzed the role of plasma biomarkers for TSU-68 in a previous phase II trial comparing TSU-68 plus docetaxel and docetaxel alone in patients with metastatic breast cancer. MATERIALS AND METHODS: A total of 77 patients were eligible for this study (38 in the TSU-68 plus docetaxel arm and 39 in the docetaxel alone arm). Blood samples were collected prior to the start of each cycle, and vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)-AA, -AB, -BB, fibroblast growth factor, M30, C-reactive protein (CRP), and interleukin 6 (IL-6) levels were measured using enzyme linked immunosorbent assay. The primary endpoint was progression-free survival (PFS). RESULTS: In patients with baseline PDGF-AA ≥ median, median PFS was significantly worse in the TSU-68 plus docetaxel group than in the docetaxel alone group (5.4 months vs. 13.7 months, p=0.049), while a trend toward a PFS benefit was observed in those with baseline PDGF-AA < median (9.7 months vs. 4.0 months, p=0.18; p for interaction=0.03). In the TSU-68 plus docetaxel group, PFS showed significant association with fold changes in CRP (p=0.001), IL-6 (p < .001), PDGF-BB (p=0.02), and VEGF (p=0.047) following the first treatment cycle. CONCLUSION: Baseline PDGF-AA levels and dynamics of VEGF, PDGF-BB, CRP, and IL-6 levels were predictive for the efficacy of TSU-68.
Assuntos
Humanos , Braço , Biomarcadores , Neoplasias da Mama , Mama , Proteína C-Reativa , Intervalo Livre de Doença , Ensaio de Imunoadsorção Enzimática , Fatores de Crescimento de Fibroblastos , Interleucina-6 , Farmacologia , Plasma , Fator de Crescimento Derivado de Plaquetas , Fator A de Crescimento do Endotélio VascularRESUMO
PURPOSE: This study was conducted to evaluate the efficacy and safety of azasetron compared to ondansetron in the prevention of delayed chemotherapy-induced nausea and vomiting. MATERIALS AND METHODS: This study was a multi-center, prospective, randomized, double-dummy, double-blind and parallel-group trial involving 12 institutions in Korea between May 2005 and December 2005. A total of 265 patients with moderately and highly emetogenic chemotherapy were included and randomly assigned to either the azasetron or ondansetron group. All patients received azasetron (10 mg intravenously) and dexamethasone (20 mg intravenously) on day 1 and dexamethasone (4 mg orally every 12 hours) on days 2-4. The azasetron group received azasetron (10 mg orally) with placebo of ondansetron (orally every 12 hours), and the ondansetron group received ondansetron (8 mg orally every 12 hours) with placebo of azasetron (orally) on days 2-6. RESULTS: Over days 2-6, the effective ratio of complete response in the azasetron and ondansetron groups was 45% and 54.5%, respectively (95% confidence interval, -21.4 to 2.5%). Thus, the non-inferiority of azasetron compared with ondansetron in delayed chemotherapy-induced nausea and vomiting was not proven in the present study. All treatments were well tolerated and no unexpected drug-related adverse events were reported. The most common adverse events related to the treatment were constipation and hiccups, and there were no differences in the overall incidence of adverse events. CONCLUSION: In the present study, azasetron showed inferiority in the control of delayed chemotherapy-induced nausea and vomiting compared with ondansetron whereas safety profiles were similar between the two groups.
Assuntos
Humanos , Antineoplásicos , Constipação Intestinal , Dexametasona , Tratamento Farmacológico , Soluço , Incidência , Coreia (Geográfico) , Náusea , Ondansetron , Estudos Prospectivos , Antagonistas da Serotonina , VômitoRESUMO
PURPOSE: Leukemic promyelocytes have the unique ability to undergo differentiation after exposure to retinoic acid and both differentiation and apoptosis after exposure to arsenic trioxide (ATO). Recent studies have shown that inhibition of Src family kinases (SFKs) resulted in enhancement of retinoic acid-induced myeloid differentiation. MATERIALS AND METHODS: In this study, we investigated the question of whether the SFK inhibitor PP2 enhanced the differentiation of NB4 cells when combined with ATO as well as when combined with all-trans-retinoic acid (ATRA). In addition, we attempted to determine the difference in retinoic acid-induced gene expression between cells treated with PP2 in combination with ATRA and in combination with ATO. RESULTS: SFK inhibitor PP2 induced significant enhancement of ATRA- or ATO-induced differentiation of NB4 cells. A significantly stronger synergistic effect was observed when PP2 was combined with ATRA than when combined with ATO. Flow cytometric analysis demonstrated a significant increase in CD11b-positive granulocytes up to 60.73% and 31.58%, respectively. These results were confirmed by nitroblue tetrazolium staining. These effects were not related to apoptosis. Results of Annexin-V-fluorescein staining revealed that PP2 combined with ATRA or PP2 combined with ATO did not induce apoptosis in NB4 cells. Retinoic acid-induced gene expression was different in both groups. Intercellular adhesion molecule-1 expression showed a significant increase in cells treated with PP2 in combination with ATRA, whereas cathepsin D expression showed a significant increase in cells treated with PP2 in combination with ATO. CONCLUSION: Our data showed that SFK inhibitor PP2 enhanced acute promyelocytic leukemia cell differentiation when combined with either ATRA or ATO with difference in activation of retinoic acid-induced genes.
Assuntos
Humanos , Apoptose , Arsênio , Arsenicais , Catepsina D , Diferenciação Celular , Linhagem Celular , Expressão Gênica , Células Precursoras de Granulócitos , Granulócitos , Molécula 1 de Adesão Intercelular , Leucemia Promielocítica Aguda , Nitroazul de Tetrazólio , Óxidos , Fosfotransferases , Pirimidinas , Quinases da Família src , TretinoínaRESUMO
Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management.
Assuntos
Idoso , Feminino , Humanos , Dor Abdominal , Tosse , Dalteparina , Cirurgia Geral , Hematoma , Hemorragia , Parto , Embolia Pulmonar , Espirro , Trombose VenosaRESUMO
Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management.
Assuntos
Idoso , Feminino , Humanos , Dor Abdominal , Tosse , Dalteparina , Cirurgia Geral , Hematoma , Hemorragia , Parto , Embolia Pulmonar , Espirro , Trombose VenosaRESUMO
Autologous hematopoietic stem cell transplantation (HSCT) is an effective treatment for patients with relapsed or high-risk Non-Hodgkin's lymphoma (NHL). HSCT fundamentally interferes with the immune system. As a consequence, development of autoimmunity after HSCT has been observed during the past several decades. Most evidence is derived from single case reports or studies on small series of patients who developed novel-onset autoimmune diseases after use of HSCT to treat various conditions. We treated 3 NHL patients with autoimmune disease among 54 NHL patients who received high-dose chemotherapy and autologous HSCT.
Assuntos
Humanos , Doenças Autoimunes , Autoimunidade , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas , Sistema Imunitário , Linfoma não Hodgkin , Transplante de Células-TroncoRESUMO
We investigated the role of fasting hormones and pro-inflammatory cytokines in cancer patients. Hormones (ghrelin, adiponectin, and leptin) and cytokines (TNF-alpha, IFN-gamma, and IL-6) were measured by ELISA or RIA in lung cancer and colorectal cancer patients before the administration of cancer therapy, and measurements were repeated every 2 months for 6 months. From June 2006 to August 2008, 42 patients (19 with colorectal cancer and 23 with lung cancer) were enrolled. In total, 21 patients were included in the cachexia group and the others served as a comparison group. No significant difference in the initial adiponectin, ghrelin, TNF-alpha, IFN-gamma, or IL-6 level was observed between groups, although leptin was significantly lower in cachectic patients than in the comparison group (15.3 +/- 19.5 vs 80.9 +/- 99.0 pg/mL, P = 0.007). During the follow-up, the patients who showed a > 5% weight gain had higher ghrelin levels after 6 months. Patients exhibiting elevated IL-6 levels typically showed a weight loss > 5% after 6 months. A blunted adiponectin or ghrelin response to weight loss may contribute to cancer cachexia and IL-6 may be responsible for inducing and maintaining cancer cachexia.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adiponectina/análise , Antineoplásicos/uso terapêutico , Caquexia/fisiopatologia , Neoplasias Colorretais/tratamento farmacológico , Citocinas/análise , Seguimentos , Grelina/análise , Interferon gama/análise , Interleucina-6/análise , Leptina/análise , Neoplasias Pulmonares/tratamento farmacológico , Hormônios Peptídicos/análise , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Fator de Necrose Tumoral alfa/análise , Aumento de Peso , Redução de PesoRESUMO
PURPOSE: The purpose of this study was to evaluate silver in situ hybridization (SISH) as an effective test to identify HER2 gene amplification in patients with breast cancer. METHODS: A systematic literature review was used to evaluate the effectiveness of SISH. The literature review covered from October 27, 2009 to December 1, 2009, and eight domestic databases including KoreaMed and foreign databases including Ovid-MEDLINE, EMBASE, and Cochrane Library were used. Keywords, such as 'silver in situ hybridization' and 'SISH', were used to search 63 documents. Ten studies regarding the evaluation of diagnostics were included in the final evaluation. The Scottish Intercollegiate Guidelines Network (SIGN) tool was used by two evaluators to independently evaluate the quality of the ten studies. RESULTS: A total of ten studies (nine diagnostic evaluation studies and one correlation study) were identified to evaluate SISH. The effectiveness of this test was evaluated based on diagnostic accuracy, concordance rate, and correlation with fluorescence in situ hybridization (FISH) results. The sensitivity of SISH was 0.81-1.00, and the specificity was 0.82-1.00. The positive predictive value was 0.95-1.00, negative predictive value was 0.81-1.00, and the test accuracy was 0.90-1.00. The concordance rate of SISH was 87.0-100% and two studies reported a correlation with FISH results. The body of evidence as a whole suggests a Grade D for SISH. CONCLUSION: SISH is a safe and useful procedure in patients with breast cancer and at least grade D evidence based on existing positive studies.
Assuntos
Valor Preditivo dos Testes , Neoplasias da MamaRESUMO
PURPOSE: This phase II clinical trial was conducted to evaluate the activity and safety of a combination treatment of paclitaxel (Genexol(R)) plus carboplatin in patients with advanced non-small cell lung cancer. MATERIALS AND METHODS: Chemotherapy-naive patients having histologically confirmed advanced or metastatic non-small cell lung cancer were enrolled. Genexol(R) was administered at 225 mg/m2 intravenous (IV) infusion over 3 hours, followed by carboplatin (area under the concentration-time curve=6) IV on day 1 every 3 weeks. RESULTS: Twenty-eight patients were enrolled between January 2003 and January 2005. A total of 110 cycles of chemotherapy were given. The median number of chemotherapy cycles was 4. A total of 25 study patients were evaluable. On an intent-to-treat basis, there were ten partial responses (response rate 35.7%). The median time-to-progression was 3.2 months (95% confidence interval [CI], 1.5 to 4.9) and the median overall survival was 8.2 months (95% CI, 4.1 to 12.3). The main hematologic grade 3/4 toxicity was neutropenia, which was observed in 14 (50.0%) patients. The main non-hematologic toxicity was peripheral neuropathy, which was observed in 12 patients (42.9%). Grade 3/4 neuropathy occurred in 8 patients (28.6%) and three patients discontinued treatment because of neuropathy. CONCLUSION: In this trial, the combination of Genexol(R) and carboplatin showed significant activity as first line treatment for patients with advanced or metastatic non-small cell lung cancer. However, a modest dose reduction of Genexol(R) is needed due to sensory neuropathy.
Assuntos
Humanos , Carboplatina , Carcinoma Pulmonar de Células não Pequenas , Pulmão , Neutropenia , Paclitaxel , Doenças do Sistema Nervoso PeriféricoRESUMO
PURPOSE: This phase II clinical trial was conducted to evaluate the activity and safety of a combination treatment of paclitaxel (Genexol(R)) plus carboplatin in patients with advanced non-small cell lung cancer. MATERIALS AND METHODS: Chemotherapy-naive patients having histologically confirmed advanced or metastatic non-small cell lung cancer were enrolled. Genexol(R) was administered at 225 mg/m2 intravenous (IV) infusion over 3 hours, followed by carboplatin (area under the concentration-time curve=6) IV on day 1 every 3 weeks. RESULTS: Twenty-eight patients were enrolled between January 2003 and January 2005. A total of 110 cycles of chemotherapy were given. The median number of chemotherapy cycles was 4. A total of 25 study patients were evaluable. On an intent-to-treat basis, there were ten partial responses (response rate 35.7%). The median time-to-progression was 3.2 months (95% confidence interval [CI], 1.5 to 4.9) and the median overall survival was 8.2 months (95% CI, 4.1 to 12.3). The main hematologic grade 3/4 toxicity was neutropenia, which was observed in 14 (50.0%) patients. The main non-hematologic toxicity was peripheral neuropathy, which was observed in 12 patients (42.9%). Grade 3/4 neuropathy occurred in 8 patients (28.6%) and three patients discontinued treatment because of neuropathy. CONCLUSION: In this trial, the combination of Genexol(R) and carboplatin showed significant activity as first line treatment for patients with advanced or metastatic non-small cell lung cancer. However, a modest dose reduction of Genexol(R) is needed due to sensory neuropathy.
Assuntos
Humanos , Carboplatina , Carcinoma Pulmonar de Células não Pequenas , Pulmão , Neutropenia , Paclitaxel , Doenças do Sistema Nervoso PeriféricoRESUMO
PURPOSE: The prognosis of gastric cancer patients with bone marrow metastases is extremely poor. The current study was conducted to evaluate the clinical outcomes of advanced gastric cancer patients with bone marrow metastases. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 26 advanced gastric cancer patients with bone marrow metastases who were treated at Soonchunhyang University Hospital between September 1986 and February 2009. RESULTS: The median age was 46 years (range, 24 to 61 years). All patients had poorly differentiated adenocarcinoma, including 17 signet ring cell carcinomas. The majority of the patients had thrombocytopenia, anemia, and elevated lactate dehydrogenase levels. Sixteen patients (61.5%) received palliative chemotherapy (median, 4 cycles; range, 1 to 13 cycles). The median overall survival after detection of bone marrow metastases for the cohort of patients was 37 days (95% confidence interval, 12.5 to 61.5 days). The median overall survival after detection of bone marrow involvement was 11 days in the best supportive care group (range, 2 to 34 days) and 121 days (range, 3 to 383 days) in the palliative chemotherapy group (p<0.001). The causes of death were tumor progression (11 patients, 45%), brain hemorrhage (6 patients, 25%), infection (5 patients, 21%), and disseminated intravascular coagulation (1 patient, 4%). There were no chemotherapy-related deaths. CONCLUSION: Palliative chemotherapy could be considered in advanced gastric cancer patients with bone marrow metastases as a treatment option.
Assuntos
Humanos , Adenocarcinoma , Anemia , Medula Óssea , Carcinoma de Células em Anel de Sinete , Causas de Morte , Estudos de Coortes , Coagulação Intravascular Disseminada , Hemorragias Intracranianas , L-Lactato Desidrogenase , Prontuários Médicos , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas , TrombocitopeniaRESUMO
PURPOSE: We retrospectively determined the efficacy and safety of the combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line chemotherapy for patients with metastatic or recurrent gastric cancer. MATERIALS AND METHODS: Between January 2006 and August 2009, 39 patients with histologically-confirmed, metastatic or recurrent gastric cancer underwent chemotherapy, and the results were retrospectively investigated. The chemotherapy regimen consisted of oxaliplatin (100 mg/m2) and FA (200 mg/m2; 2-hour infusion), then 5-FU (2,400 mg/m2; 46-hour continuous infusion) every 2 weeks. RESULTS: Thirty-nine patients received a total of 210 treatment cycles. The median number of cycles was 6 (range, 1 to 16). Of the 32 evaluable patients, zero patients achieved a complete response and 11 patients achieved a partial response (response rate, 28.2%). The median time-to-progression and overall survival were 4.3 months (95% confidence interval [CI], 2.0 to 6.5 months) and 9.8 months (95% CI, 3.5 to 16.0 months), respectively. The main hematologic toxicity was anemia, which was observed in 119 cycles (56.7%). Grade 3/4 neutropenia was observed in 32 cycles (15.2%). The main non-hematologic toxicity was constipation, which was observed in 91 cycles (46.2%). Peripheral neuropathy occurred in 71 cycles (33.8%); all cases were grade 1 or 2. No treatment-related deaths were reported. CONCLUSION: This study showed that combination chemotherapy with oxaliplatin, 5-FU, and FA is an active and well-tolerated regimen as first-line treatment in patients with metastatic or recurrent gastric cancer.
Assuntos
Humanos , Anemia , Constipação Intestinal , Quimioterapia Combinada , Fluoruracila , Leucovorina , Neutropenia , Compostos Organoplatínicos , Doenças do Sistema Nervoso Periférico , Estudos Retrospectivos , Neoplasias GástricasRESUMO
PURPOSE: We retrospectively determined the efficacy and safety of the combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line chemotherapy for patients with metastatic or recurrent gastric cancer. MATERIALS AND METHODS: Between January 2006 and August 2009, 39 patients with histologically-confirmed, metastatic or recurrent gastric cancer underwent chemotherapy, and the results were retrospectively investigated. The chemotherapy regimen consisted of oxaliplatin (100 mg/m2) and FA (200 mg/m2; 2-hour infusion), then 5-FU (2,400 mg/m2; 46-hour continuous infusion) every 2 weeks. RESULTS: Thirty-nine patients received a total of 210 treatment cycles. The median number of cycles was 6 (range, 1 to 16). Of the 32 evaluable patients, zero patients achieved a complete response and 11 patients achieved a partial response (response rate, 28.2%). The median time-to-progression and overall survival were 4.3 months (95% confidence interval [CI], 2.0 to 6.5 months) and 9.8 months (95% CI, 3.5 to 16.0 months), respectively. The main hematologic toxicity was anemia, which was observed in 119 cycles (56.7%). Grade 3/4 neutropenia was observed in 32 cycles (15.2%). The main non-hematologic toxicity was constipation, which was observed in 91 cycles (46.2%). Peripheral neuropathy occurred in 71 cycles (33.8%); all cases were grade 1 or 2. No treatment-related deaths were reported. CONCLUSION: This study showed that combination chemotherapy with oxaliplatin, 5-FU, and FA is an active and well-tolerated regimen as first-line treatment in patients with metastatic or recurrent gastric cancer.
Assuntos
Humanos , Anemia , Constipação Intestinal , Quimioterapia Combinada , Fluoruracila , Leucovorina , Neutropenia , Compostos Organoplatínicos , Doenças do Sistema Nervoso Periférico , Estudos Retrospectivos , Neoplasias GástricasRESUMO
Type B lactic acidosis is a rare condition in patients with solid tumors or hematological malignancies. Although there have been several theories to explain its mechanism, the exact cause of lactic acidosis remains to be discovered. Lactic acidosis is usually related to increased tumor burden in patients with malignancy. We experienced a case of lactic acidosis in a 39-year-old man who visited an emergency room because of dyspnea, and the cause of lactic acidosis turned out to be recurrent acute leukemia. Chemotherapy relieved the degree of lactic acidosis initially, but as the disease progressed, lactic acidosis became aggravated. Type B lactic acidosis can be a clinical presentation of acute exacerbation of acute leukemia.
Assuntos
Adulto , Humanos , Masculino , Acidose Láctica/diagnóstico , Doença Aguda , Leucemia/complicaçõesRESUMO
Involvement of the central nervous system is very uncommon in multiple myeloma, observed in approximately 1% of the multiple myeloma patients. We report a case of central nervous system myelomatosis with complex chromosome aberrations in a 62-yr-old female patient, who had previously been diagnosed as multiple myeloma. Fluorescent in situ hybridization revealed 13q deletion, p53 gene deletion and IGH/FGFR3 rearrangement and chromosomal study showed complex chromosome aberrations. After four cycles of chemotherapy, the patient was admitted to the hematology department with severe headache. Plasma cells were found in the cerebrospinal fluid (CSF), and CSF immunoelectrophoresis revealed abnormal precipitin arcs against anti-IgG and anti-lambda antisera. She was given systemic chemotherapy and eight courses of intrathecal chemotherapy, which cleared plasma cells in the CSF. Two months later, she was given autologous stem cell transplantation. Three months after stem cell transplantation, central nervous system myelomatosis progressed to plasma cell leukemia and two months later,the patient expired.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Antineoplásicos/uso terapêutico , Neoplasias do Sistema Nervoso Central/diagnóstico , Líquido Cefalorraquidiano/citologia , Deleção Cromossômica , Terapia Combinada , Progressão da Doença , Deleção de Genes , Imunoeletroforese , Hibridização in Situ Fluorescente , Leucemia Plasmocitária/diagnóstico , Mieloma Múltiplo/diagnóstico , Plasmócitos/patologia , Precipitinas/metabolismo , Receptor Tipo 3 de Fator de Crescimento de Fibroblastos/genética , Transplante de Células-Tronco , Translocação Genética , Transplante Autólogo , Proteína Supressora de Tumor p53/genéticaRESUMO
PURPOSE: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. METHODS: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. RESULTS: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). CONCLUSION: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.
Assuntos
Humanos , Masculino , Cateterismo , Cateterismo Venoso Central , Catéteres , Cateteres Venosos Centrais , Estimativa de Kaplan-Meier , Coreia (Geográfico) , Análise Multivariada , Nutrição Parenteral , Estudos Retrospectivos , TromboseRESUMO
This study investigated the safety and effectiveness of each type of central venous catheters (CVC) in patients with cancer. We prospectively enrolled patients with cancer who underwent catherization involving a subclavian venous catheter (SVC), peripherally inserted central venous catheter (PICC), or chemo-port (CP) in our department. From March 2007 to March 2009, 116 patients underwent 179 episodes of catherization. A SVC was inserted most frequently (46.4%). Fifty-four complications occurred (30.1%): infection in 23 cases, malpositioning or migration of the tip in 18 cases, thrombosis in eight cases, and bleeding in five cases. Malpositioning or migration of the tip occurred more frequently with a PICC (P<0.001); infection occurred more often with a tunneled catheter (P=0.028) and was observed more often in young patients (P=0.023). The catheter life span was longer for patients with solid cancer (P=0.002) than for those with hematologic cancer, with a CP (P<0.001) than a PICC or SVC, and for an indwelling catheter with image guidance (P=0.014) than a blind procedure. In conclusion, CP is an effective tool for long term use and the fixation of tip is important for the management of PICC.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Falha de Equipamento , Hemorragia/epidemiologia , Neoplasias/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Trombose/epidemiologiaRESUMO
BACKGROUND/AIMS: This study compared the clinical benefits of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) with pemetrexed to identify the clinical parameters that correlated with response. METHODS: A retrospective chart review examined patients who were 1) treated with EGFR TKI or pemetrexed, 2) diagnosed with advanced non-squamous non-small-cell lung cancer, and 3) previously treated with platinum-based chemotherapy in Soonchunhyang Bucheon Hospital. RESULTS: Sixty-one patients (18 erlotinib, 18 gefitinib, 25 pemetrexed) were investigated from February 2002 to August 2009. The median follow-up period was 37 months (7~97 months). Overall, their median age was 63 years, 41 patients were non-smokers, 57 patients had adenocarcinoma, and 55 patients were at stage IV. Twenty-one patients received the study drugs as second-line chemotherapy, and others as third-line or more. No significant differences in the overall response rate (erlotinib 33.3% vs. gefitinib 38.9% vs. pemetrexed 20.0%) and progression-free survival (erlotinib 1.9 months vs. gefitinib 3.0 months vs. pemetrexed 2.9 months) were found among the three groups. Female gender was related to a good response to EGFR TKIs (p=0.047). Skin rash in the erlotinib group (p=0.037) and adenocarcinoma in the pemetrexed group (p=0.02) were related to improved progression-free survival. Few side effects were reported. CONCLUSIONS: Both EGFR TKIs and pemetrexed therapy for non-squamous non-small-cell lung cancer were efficient and tolerable after the failure of first-line platinum-based chemotherapy. Further prospective studies are needed to validate the predictive role of the suggested clinical parameters in this study.