Publication date: Available online 20 October 2016
Source:Hematology/Oncology and Stem Cell Therapy
Author(s): Igor Stoma, Igor Karpov, Anatoly Uss, Oleg Rummo, Natalia Milanovich, Igor Iskrov
[Objective/Background]A decision about the need for antimicrobial therapy in a patient with febrile neutropenia after hematopoietic stem cell transplantation (HSCT) is often complicated because of the low frequency of culture isolation and reduced clinical manifestation of infection. Usefulness and choice of sepsis biomarkers to distinguish bloodstream infection (BSI) from other causes of febrile episode is still argued in HSCT recipients in modern epidemiological situations characterized by the emergence of highly resistant gram-negative microorganisms. In this study a comparative analysis of diagnostic values of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) was performed as sepsis biomarkers in adult patients after HSCT in a condition of high prevalence of gram-negative pathogens.[Methods]A prospective observational clinical study was performed at the Center of Hematology and Bone Marrow Transplantation in Minsk, Republic of Belarus. The biomarkers (presepsin, PCT, and CRP) were assessed in a 4-hour period after the onset of febrile neutropenia episode in adult patients after HSCT. Microbiologically-confirmed BSI caused by a gram-negative pathogen was set as a primary outcome.[Results]Clinical and laboratory data were analyzed in 52 neutropenic patients after HSCT aged 18–79 years. Out of the biomarkers assessed, the best diagnostic value was shown in presepsin (area under the curve [AUC]: 0.889, 95% confidence interval [CI]: 0.644–0.987, p < .0001) with 75% sensitivity and 100% specificity, then in PCT (AUC: 0.741, 95% CI: 0.573–0.869, p = .0037) with 62% sensitivity and 88% specificity. The optimal cut-off value for CRP was set as 165 mg/L, while it had an average diagnostic value (AUC: 0.707, 95% CI: 0.564–0.825, p = .0049) with low sensitivity (40%) and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT.[Conclusion]Presepsin may be recommended in adult patients with suspected gram-negative BSI after HSCT as a possible additional supplementary test with a cut-off value of 218 pg/mL. PCT is inferior to presepsin in terms of sensitivity and specificity, but still shows a good quality of diagnostic value with an optimal cut-off value of 1.5 ng/mL. CRP showed an average diagnostic value with low sensitivity (40%) and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT in a condition of high prevalence of gram-negative pathogens.
http://ift.tt/2esNHem
Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 25 Οκτωβρίου 2016
Diagnostic Value of Sepsis Biomarkers in Hematopoietic Stem Cell Transplant Recipients in a Condition of High Prevalence of Gram-negative Pathogens
A Comparison of Extremity Thrombosis Rates in Adolescent and Young Adult Versus Younger Pediatric Oncology Patients at a Children's Hospital
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
http://ift.tt/2eOG7YL
Risk–Benefit Analysis of Pediatric-Inspired Versus Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicin, and Dexamethasone Protocols for Acute Lymphoblastic Leukemia in Adolescents and Young Adults
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
http://ift.tt/2dUimR5
A Comparison of Extremity Thrombosis Rates in Adolescent and Young Adult Versus Younger Pediatric Oncology Patients at a Children's Hospital
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
from Cancer via ola Kala on Inoreader http://ift.tt/2eOG7YL
via IFTTT
Risk–Benefit Analysis of Pediatric-Inspired Versus Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicin, and Dexamethasone Protocols for Acute Lymphoblastic Leukemia in Adolescents and Young Adults
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
from Cancer via ola Kala on Inoreader http://ift.tt/2dUimR5
via IFTTT
A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men
by Yuan-Hua Wu, Chia-Jui Yen, Jenn-Ren Hsiao, Chun-Yen Ou, Jehn-Shyun Huang, Tung-Yiu Wong, Sen-Tien Tsai, Cheng-Chih Huang, Wei-Ting Lee, Ken-Chung Chen, Sheen-Yie Fang, Jiunn-Liang Wu, Wei-Ting Hsueh, Forn-Chia Lin, Ming-Wei Yang, Jang-Yang Chang, Hsiao-Chen Liao, Shang-Yin Wu, Chen-Lin Lin, Yi-Hui Wang, Ya-Ling Weng, Han-Chien Yang, Yu-Shan Chen, Jeffrey S. Chang
ObjectivesAlthough betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The current study was conducted to fill these insufficiencies.
Materials and MethodsA hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression.
ResultsEver BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan.
ConclusionOur results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing.
http://ift.tt/2ero3JD
LIM-Only Protein 4 (LMO4) and LIM Domain Binding Protein 1 (LDB1) Promote Growth and Metastasis of Human Head and Neck Cancer (LMO4 and LDB1 in Head and Neck Cancer)
by Elizabeth A. Simonik, Ying Cai, Katherine N. Kimmelshue, Dana M. Brantley-Sieders, Holli A. Loomans, Claudia D. Andl, Grant M. Westlake, Victoria M. Youngblood, Jin Chen, Wendell G. Yarbrough, Brandee T. Brown, Lalitha Nagarajan, Stephen J. Brandt
Squamous cell carcinoma of the head and neck (HNSCC) accounts for more than 300,000 deaths worldwide per year as a consequence of tumor cell invasion of adjacent structures or metastasis. LIM-only protein 4 (LMO4) and LIM-domain binding protein 1 (LDB1), two directly interacting transcriptional adaptors that have important roles in normal epithelial cell differentiation, have been associated with increased metastasis, decreased differentiation, and shortened survival in carcinoma of the breast. Here, we implicate two LDB1-binding proteins, single-stranded binding protein 2 (SSBP2) and 3 (SSBP3), in controlling LMO4 and LDB1 protein abundance in HNSCC and in regulating specific tumor cell functions in this disease. First, we found that the relative abundance of LMO4, LDB1, and the two SSBPs correlated very significantly in a panel of human HNSCC cell lines. Second, expression of these proteins in tumor primaries and lymph nodes involved by metastasis were concordant in 3 of 3 sets of tissue. Third, using a Matrigel invasion and organotypic reconstruct assay, CRISPR/Cas9-mediated deletion of LDB1 in the VU-SCC-1729 cell line, which is highly invasive of basement membrane and cellular monolayers, reduced tumor cell invasiveness and migration, as well as proliferation on tissue culture plastic. Finally, inactivation of the LDB1 gene in these cells decreased growth and vascularization of xenografted human tumor cells in vivo. These data show that LMO4, LDB1, and SSBP2 and/or SSBP3 regulate metastasis, proliferation, and angiogenesis in HNSCC and provide the first evidence that SSBPs control LMO4 and LDB1 protein abundance in a cancer context.http://ift.tt/2eDbYwc
A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men
by Yuan-Hua Wu, Chia-Jui Yen, Jenn-Ren Hsiao, Chun-Yen Ou, Jehn-Shyun Huang, Tung-Yiu Wong, Sen-Tien Tsai, Cheng-Chih Huang, Wei-Ting Lee, Ken-Chung Chen, Sheen-Yie Fang, Jiunn-Liang Wu, Wei-Ting Hsueh, Forn-Chia Lin, Ming-Wei Yang, Jang-Yang Chang, Hsiao-Chen Liao, Shang-Yin Wu, Chen-Lin Lin, Yi-Hui Wang, Ya-Ling Weng, Han-Chien Yang, Yu-Shan Chen, Jeffrey S. Chang
ObjectivesAlthough betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The current study was conducted to fill these insufficiencies.
Materials and MethodsA hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression.
ResultsEver BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan.
ConclusionOur results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing.
from Cancer via ola Kala on Inoreader http://ift.tt/2ero3JD
via IFTTT
LIM-Only Protein 4 (LMO4) and LIM Domain Binding Protein 1 (LDB1) Promote Growth and Metastasis of Human Head and Neck Cancer (LMO4 and LDB1 in Head and Neck Cancer)
by Elizabeth A. Simonik, Ying Cai, Katherine N. Kimmelshue, Dana M. Brantley-Sieders, Holli A. Loomans, Claudia D. Andl, Grant M. Westlake, Victoria M. Youngblood, Jin Chen, Wendell G. Yarbrough, Brandee T. Brown, Lalitha Nagarajan, Stephen J. Brandt
Squamous cell carcinoma of the head and neck (HNSCC) accounts for more than 300,000 deaths worldwide per year as a consequence of tumor cell invasion of adjacent structures or metastasis. LIM-only protein 4 (LMO4) and LIM-domain binding protein 1 (LDB1), two directly interacting transcriptional adaptors that have important roles in normal epithelial cell differentiation, have been associated with increased metastasis, decreased differentiation, and shortened survival in carcinoma of the breast. Here, we implicate two LDB1-binding proteins, single-stranded binding protein 2 (SSBP2) and 3 (SSBP3), in controlling LMO4 and LDB1 protein abundance in HNSCC and in regulating specific tumor cell functions in this disease. First, we found that the relative abundance of LMO4, LDB1, and the two SSBPs correlated very significantly in a panel of human HNSCC cell lines. Second, expression of these proteins in tumor primaries and lymph nodes involved by metastasis were concordant in 3 of 3 sets of tissue. Third, using a Matrigel invasion and organotypic reconstruct assay, CRISPR/Cas9-mediated deletion of LDB1 in the VU-SCC-1729 cell line, which is highly invasive of basement membrane and cellular monolayers, reduced tumor cell invasiveness and migration, as well as proliferation on tissue culture plastic. Finally, inactivation of the LDB1 gene in these cells decreased growth and vascularization of xenografted human tumor cells in vivo. These data show that LMO4, LDB1, and SSBP2 and/or SSBP3 regulate metastasis, proliferation, and angiogenesis in HNSCC and provide the first evidence that SSBPs control LMO4 and LDB1 protein abundance in a cancer context.from Cancer via ola Kala on Inoreader http://ift.tt/2eDbYwc
via IFTTT
The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer
Abstract
Purpose
We evaluated the prognostic significance of the peripheral lymphocyte count and lymphocyte percentage, which reflect the preoperative immune status, in patients with colorectal cancer (CRC) and then compared their accuracy as predictors of the survival.
Methods
We retrospectively reviewed a database of 362 patients. We classified the patients into high lymphocyte count and low lymphocyte count groups. We also classified the patients into high lymphocyte percentage and low lymphocyte percentage groups.
Results
The 5-year relapse-free survival (RFS) rate in the high lymphocyte count group tended to be higher than that in the low lymphocyte count group. The 5-year overall survival (OS) rate in the high lymphocyte count group was significantly higher than that in the low lymphocyte count group. In contrast, the 5-year RFS and OS rates in the high lymphocyte percentage group were both significantly higher than those in the low lymphocyte percentage group. A multivariate analysis showed that the lymphocyte percentage was independently associated with the OS.
Conclusions
These findings suggest that the lymphocyte percentage is a good predictor of the OS and may be a stronger predictor of survival than the lymphocyte count in CRC patients.
from Cancer via ola Kala on Inoreader http://ift.tt/2dGML1W
via IFTTT
Radiation-induced fibrosis in the boost area after three-dimensional conformal radiotherapy with a simultaneous integrated boost technique for early-stage breast cancer: A multivariable prediction model
To develop a multivariable prediction model for the risk of grade⩾2 fibrosis in the boost area after breast conserving surgery (BCS) followed by three-dimensional conformal radiotherapy (RT) with a simultaneous integrated photon boost (3D-CRT-SIB), five years after RT.
http://ift.tt/2f5o8C9
Combined modalities of magnetic resonance imaging, endoscopy and computed tomography in the evaluation of tumor responses to definitive chemoradiotherapy in esophageal squamous cell carcinoma
To explore the value of combined modalities, including anatomical and functional magnetic resonance imaging (MRI), endoscopy and computed tomography (CT), for the assessment of tumor responses to definitive chemoradiotherapy (dCRT) in esophageal squamous cell carcinoma (ESCC).
http://ift.tt/2eCCnwU
Conservative surgery with combined high dose rate brachytherapy for patients suffering from genitourinary and perianal rhabdomyosarcoma
Outcome of patients with genitourinary rhabdomyosarcoma has been improved in the past, but organ preservation rates are too low. Conservative surgery with LDR-brachytherapy has been advocated, but LDR-brachytherapy is often not available. We wanted to establish a novel treatment modality combining HDR-brachytherapy and conservative surgery.
http://ift.tt/2eDPc7q
Stereotactic radiotherapy of the tumor bed compared to whole brain radiotherapy after surgery of single brain metastasis: Results from a randomized trial
To evaluate if neurological/cognitive function outcomes in patients with resected single brain metastasis (BM) after stereotactic radiotherapy of the tumor bed (SRT-TB) are not inferior compared to those achieved with whole-brain radiotherapy (WBRT).
http://ift.tt/2eCB54S
The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer
Abstract
Purpose
We evaluated the prognostic significance of the peripheral lymphocyte count and lymphocyte percentage, which reflect the preoperative immune status, in patients with colorectal cancer (CRC) and then compared their accuracy as predictors of the survival.
Methods
We retrospectively reviewed a database of 362 patients. We classified the patients into high lymphocyte count and low lymphocyte count groups. We also classified the patients into high lymphocyte percentage and low lymphocyte percentage groups.
Results
The 5-year relapse-free survival (RFS) rate in the high lymphocyte count group tended to be higher than that in the low lymphocyte count group. The 5-year overall survival (OS) rate in the high lymphocyte count group was significantly higher than that in the low lymphocyte count group. In contrast, the 5-year RFS and OS rates in the high lymphocyte percentage group were both significantly higher than those in the low lymphocyte percentage group. A multivariate analysis showed that the lymphocyte percentage was independently associated with the OS.
Conclusions
These findings suggest that the lymphocyte percentage is a good predictor of the OS and may be a stronger predictor of survival than the lymphocyte count in CRC patients.
http://ift.tt/2dGML1W
Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy
Abstract
Purpose
Using prospectively collected patient-related, dose-related, and pulmonary function test (PFT) data before radiotherapy (RT) and at several follow-up visits after RT, the time course of PFT changes after high-dose radio(chemo)therapy and influencing factors were analyzed.
Materials and methods
From April 2012 to October 2015, 81 patients with non-small-cell lung carcinoma (NSCLC), small cell lung carcinoma (SCLC), or esophageal carcinoma where treated with high-dose radio(chemo)therapy. PFT data were collected before treatment and 6 weeks, 12 weeks, and 6 months after RT. The influence of patient- and treatment-related factors on PFT was analyzed.
Results
Mean forced expiratory volume in 1 s (FEV1) constantly declined during follow-up (p = 0.001). In total, 68% of patients had a reduced FEV1 at 6 months. Mean vital capacity (VC) didn't change during follow-up (p > 0.05). Mean total lung capacity (TLC) showed a constant decline after RT (p = 0.026). At 6 months, 60% of patients showed a decline in VC and 73% in TLC. The mean diffusion capacity for carbon monoxide (DLCO) declined at 6 and 12 weeks, but recovered slightly at 6 months (p < 0.0005). At 6 months, 86% of patients had a reduced DLCO. After treatment, the partial pressure of CO2 in the blood (pCO2) was increased and pO2 was decreased (p > 0.05). Only the pretreatment PFT classification had a significant influence on the post-RT FEV1.
Conclusion
DLCO seems to be the most reliable indicator for lung tissue damage after thoracic RT. Ventilation parameters appear to be less reliable. Concerning patient- or treatment-related factors, no reliable conclusion can be drawn regarding which factors may be relevant.
http://ift.tt/2dGHvvm
Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: Analysis of the National Cancer Database
BACKGROUND
Stage II and III rectal cancers have been effectively treated with neoadjuvant chemoradiotherapy (NCRT) followed by definitive resection. Advancements in surgical technique and systemic therapy have prompted investigation of neoadjuvant multiagent chemotherapy (NMAC) regimens with the elimination of radiation (RT). The objective of the current study was to investigate factors that predict for the use of NCRT versus NMAC and compare outcomes using the National Cancer Data Base (NCDB) for select stage II and III rectal cancers.
METHODS
In the NCDB, 21,707 patients from 2004 through 2012 with clinical T2N1 (cT2N1), cT3N0, or cT3N1 rectal cancers were identified who had received NCRT or NMAC followed by low anterior resection. Kaplan-Meier analyses, log-rank tests, and Cox-proportional hazards regression analyses were conducted along with propensity score matching analysis to reduce treatment selection bias.
RESULTS
The 5-year actuarial overall survival (OS) rate was 75% for patients who received NCRT versus 67.2% for those who received NMAC (P < .01). On MVA, those who received NCRT had improved OS (hazard ratio, 0.77. P < .01), and this effect was confirmed on propensity score matching analysis (hazard ratio, 0.72; P = .01). In the same model, the following variables improved OS: age < 65 years, having private insurance, treatment at an academic center, living in an affluent zip code, a low comorbidity score, receipt of adjuvant chemotherapy, and a shorter interval before surgery (all P < .05). African Americans, men, patients with high-grade tumors, those with cT3N1 tumors, and those who underwent incomplete (R1) resection had worse OS (all P < .05).
CONCLUSIONS
In this series, the elimination of neoadjuvant RT for select patients with stage II and III rectal adenocarcinoma was associated with worse OS and should not be recommended outside of a clinical trial. Cancer 2016. © 2016 American Cancer Society.
http://ift.tt/2eDx4dV
Initiation of and adherence to tamoxifen and aromatase inhibitor therapy among elderly women with ductal carcinoma in situ
BACKGROUND
The National Surgical Adjuvant Breast and Bowel Project B35 and International Breast Cancer Intervention Studies II Ductal Carcinoma In Situ trials showed similar treatment effects of anastrozole and tamoxifen in reducing cancer recurrence risk among ductal carcinoma in situ (DCIS) patients. Studies have shown low levels of hormone therapy drug initiation for DCIS patients, but the current body of literature lacks information on the 5-year adherence rates for these drugs from population-based studies.
METHODS
This study evaluated the initiation and 5-year adherence levels for women aged 66 to 85 years who had been diagnosed with estrogen receptor (ER)–positive DCIS between 2007 and 2011 according to the Surveillance, Epidemiology, and End Results and Texas Cancer Registry databases linked to Medicare claims. Chi-square tests, trend tests, and logistic regression were used to identify factors associated with treatment initiation.
RESULTS
There were 2871 women with ER-positive DCIS, and approximately 45% began treatment with tamoxifen or aromatase inhibitors (AIs) within 1 year of their DCIS diagnosis. The median age was 73 years for the users and 75 years for the nonusers. Women aged 66 to 70 years who underwent lumpectomy and radiation therapy were significantly more likely to initiate hormone therapy. The initiation of therapy was also significantly associated with patients' geographic location, education, marital status, diagnosis year, and race/ethnicity. Among users, adherence decreased from 67% in the first year to 30% in the fifth year.
CONCLUSIONS
Initiation and adherence levels for tamoxifen or AIs among older women with ER-positive DCIS are low. Future studies should develop methods to ensure that informed discussions take place between health care providers and patients regarding hormonal therapy for cancer prevention. Cancer 2016. © 2016 American Cancer Society.
http://ift.tt/2dTCfYu
Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: Analysis of the National Cancer Database
BACKGROUND
Stage II and III rectal cancers have been effectively treated with neoadjuvant chemoradiotherapy (NCRT) followed by definitive resection. Advancements in surgical technique and systemic therapy have prompted investigation of neoadjuvant multiagent chemotherapy (NMAC) regimens with the elimination of radiation (RT). The objective of the current study was to investigate factors that predict for the use of NCRT versus NMAC and compare outcomes using the National Cancer Data Base (NCDB) for select stage II and III rectal cancers.
METHODS
In the NCDB, 21,707 patients from 2004 through 2012 with clinical T2N1 (cT2N1), cT3N0, or cT3N1 rectal cancers were identified who had received NCRT or NMAC followed by low anterior resection. Kaplan-Meier analyses, log-rank tests, and Cox-proportional hazards regression analyses were conducted along with propensity score matching analysis to reduce treatment selection bias.
RESULTS
The 5-year actuarial overall survival (OS) rate was 75% for patients who received NCRT versus 67.2% for those who received NMAC (P < .01). On MVA, those who received NCRT had improved OS (hazard ratio, 0.77. P < .01), and this effect was confirmed on propensity score matching analysis (hazard ratio, 0.72; P = .01). In the same model, the following variables improved OS: age < 65 years, having private insurance, treatment at an academic center, living in an affluent zip code, a low comorbidity score, receipt of adjuvant chemotherapy, and a shorter interval before surgery (all P < .05). African Americans, men, patients with high-grade tumors, those with cT3N1 tumors, and those who underwent incomplete (R1) resection had worse OS (all P < .05).
CONCLUSIONS
In this series, the elimination of neoadjuvant RT for select patients with stage II and III rectal adenocarcinoma was associated with worse OS and should not be recommended outside of a clinical trial. Cancer 2016. © 2016 American Cancer Society.
from Cancer via ola Kala on Inoreader http://ift.tt/2eDx4dV
via IFTTT
Initiation of and adherence to tamoxifen and aromatase inhibitor therapy among elderly women with ductal carcinoma in situ
BACKGROUND
The National Surgical Adjuvant Breast and Bowel Project B35 and International Breast Cancer Intervention Studies II Ductal Carcinoma In Situ trials showed similar treatment effects of anastrozole and tamoxifen in reducing cancer recurrence risk among ductal carcinoma in situ (DCIS) patients. Studies have shown low levels of hormone therapy drug initiation for DCIS patients, but the current body of literature lacks information on the 5-year adherence rates for these drugs from population-based studies.
METHODS
This study evaluated the initiation and 5-year adherence levels for women aged 66 to 85 years who had been diagnosed with estrogen receptor (ER)–positive DCIS between 2007 and 2011 according to the Surveillance, Epidemiology, and End Results and Texas Cancer Registry databases linked to Medicare claims. Chi-square tests, trend tests, and logistic regression were used to identify factors associated with treatment initiation.
RESULTS
There were 2871 women with ER-positive DCIS, and approximately 45% began treatment with tamoxifen or aromatase inhibitors (AIs) within 1 year of their DCIS diagnosis. The median age was 73 years for the users and 75 years for the nonusers. Women aged 66 to 70 years who underwent lumpectomy and radiation therapy were significantly more likely to initiate hormone therapy. The initiation of therapy was also significantly associated with patients' geographic location, education, marital status, diagnosis year, and race/ethnicity. Among users, adherence decreased from 67% in the first year to 30% in the fifth year.
CONCLUSIONS
Initiation and adherence levels for tamoxifen or AIs among older women with ER-positive DCIS are low. Future studies should develop methods to ensure that informed discussions take place between health care providers and patients regarding hormonal therapy for cancer prevention. Cancer 2016. © 2016 American Cancer Society.
from Cancer via ola Kala on Inoreader http://ift.tt/2dTCfYu
via IFTTT
Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery
Abstract
Background
Rectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient.
Methods
We retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.
Results
Complications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery.
Conclusions
Five types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.
from Cancer via ola Kala on Inoreader http://ift.tt/2dTt8XU
via IFTTT
Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery
Abstract
Background
Rectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient.
Methods
We retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.
Results
Complications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery.
Conclusions
Five types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.
http://ift.tt/2dTt8XU
High-efficiency lysis of cervical cancer by allogeneic NK cells derived from umbilical cord progenitors is independent of HLA status
Abstract
Down-regulation of HLA in tumor cells, low numbers and dysfunctionality of NK cells are commonly observed in patients with end-stage cervical cancer. Adoptive transfer of high numbers of cytotoxic NK cells might be a promising treatment approach in this setting. Here, we explored the cytotoxic efficacy on ten cervical cancer cell lines of activated allogeneic NK cells from two sources, i.e., peripheral blood (PBNK) with and without cetuximab (CET), a tumor-specific monoclonal antibody directed against EGFR, or derived from umbilical cord blood (UCB-NK). Whereas CET monotherapy was ineffective against the panel of cervical cancer cell lines, irrespective of their EGFR expression levels and despite their RAS wt status, it significantly enhanced the in vitro cytotoxic efficacy of activated PBNK (P = 0.002). Equally superior cytotoxicity over activated PBNK alone was achieved by UCB-NK (P < 0.001). Both PBNK- and UCB-NK-mediated cytotoxic activity was dependent on the NK-activating receptors natural killer group 2, member D receptor (NKG2D) and DNAX accessory molecule-1 (DNAM-1) (P < 0.05) and unrelated to expression levels of the inhibitory receptors HLA-E and/or HLA-G. Most strikingly, whereas the PBNK's cytotoxic activity was inversely correlated with HLA-ABC levels (P = 0.036), PBNK + CET and UCB-NK cytotoxicity were entirely independent of HLA-ABC expression. In conclusion, this study provides a rationale to initiate a clinical trial for cervical cancer with adoptively transferred allogeneic NK cells, employing either UCB-NK or PBNK + CET for EGFR-expressing tumors. Adoptive transfer of UCB-NK might serve as a generally applicable treatment for cervical cancer, enabled by HLA-, histology- and HPV-independent killing mechanisms.
http://ift.tt/2f4ZeTd
High-efficiency lysis of cervical cancer by allogeneic NK cells derived from umbilical cord progenitors is independent of HLA status
Abstract
Down-regulation of HLA in tumor cells, low numbers and dysfunctionality of NK cells are commonly observed in patients with end-stage cervical cancer. Adoptive transfer of high numbers of cytotoxic NK cells might be a promising treatment approach in this setting. Here, we explored the cytotoxic efficacy on ten cervical cancer cell lines of activated allogeneic NK cells from two sources, i.e., peripheral blood (PBNK) with and without cetuximab (CET), a tumor-specific monoclonal antibody directed against EGFR, or derived from umbilical cord blood (UCB-NK). Whereas CET monotherapy was ineffective against the panel of cervical cancer cell lines, irrespective of their EGFR expression levels and despite their RAS wt status, it significantly enhanced the in vitro cytotoxic efficacy of activated PBNK (P = 0.002). Equally superior cytotoxicity over activated PBNK alone was achieved by UCB-NK (P < 0.001). Both PBNK- and UCB-NK-mediated cytotoxic activity was dependent on the NK-activating receptors natural killer group 2, member D receptor (NKG2D) and DNAX accessory molecule-1 (DNAM-1) (P < 0.05) and unrelated to expression levels of the inhibitory receptors HLA-E and/or HLA-G. Most strikingly, whereas the PBNK's cytotoxic activity was inversely correlated with HLA-ABC levels (P = 0.036), PBNK + CET and UCB-NK cytotoxicity were entirely independent of HLA-ABC expression. In conclusion, this study provides a rationale to initiate a clinical trial for cervical cancer with adoptively transferred allogeneic NK cells, employing either UCB-NK or PBNK + CET for EGFR-expressing tumors. Adoptive transfer of UCB-NK might serve as a generally applicable treatment for cervical cancer, enabled by HLA-, histology- and HPV-independent killing mechanisms.
from Cancer via ola Kala on Inoreader http://ift.tt/2f4ZeTd
via IFTTT
High-efficiency lysis of cervical cancer by allogeneic NK cells derived from umbilical cord progenitors is independent of HLA status
Abstract
Down-regulation of HLA in tumor cells, low numbers and dysfunctionality of NK cells are commonly observed in patients with end-stage cervical cancer. Adoptive transfer of high numbers of cytotoxic NK cells might be a promising treatment approach in this setting. Here, we explored the cytotoxic efficacy on ten cervical cancer cell lines of activated allogeneic NK cells from two sources, i.e., peripheral blood (PBNK) with and without cetuximab (CET), a tumor-specific monoclonal antibody directed against EGFR, or derived from umbilical cord blood (UCB-NK). Whereas CET monotherapy was ineffective against the panel of cervical cancer cell lines, irrespective of their EGFR expression levels and despite their RAS wt status, it significantly enhanced the in vitro cytotoxic efficacy of activated PBNK (P = 0.002). Equally superior cytotoxicity over activated PBNK alone was achieved by UCB-NK (P < 0.001). Both PBNK- and UCB-NK-mediated cytotoxic activity was dependent on the NK-activating receptors natural killer group 2, member D receptor (NKG2D) and DNAX accessory molecule-1 (DNAM-1) (P < 0.05) and unrelated to expression levels of the inhibitory receptors HLA-E and/or HLA-G. Most strikingly, whereas the PBNK's cytotoxic activity was inversely correlated with HLA-ABC levels (P = 0.036), PBNK + CET and UCB-NK cytotoxicity were entirely independent of HLA-ABC expression. In conclusion, this study provides a rationale to initiate a clinical trial for cervical cancer with adoptively transferred allogeneic NK cells, employing either UCB-NK or PBNK + CET for EGFR-expressing tumors. Adoptive transfer of UCB-NK might serve as a generally applicable treatment for cervical cancer, enabled by HLA-, histology- and HPV-independent killing mechanisms.
from Cancer via ola Kala on Inoreader http://ift.tt/2f4ZeTd
via IFTTT
Intravenous thrombolysis in a patient taking warfarin with an international normalised ratio of 1.9
Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has strict eligibility criteria. Symptomatic intracranial haemorrhage (sICH) is the most adverse complication. A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome. This is the first fully documented case report of the contraindicated use of intravenous thrombolysis in a patient presenting with an acute ischaemic stroke on a background of concurrent use of warfarin with an international normalised ratio (INR) as high as 1.9. It has been perceived that the risk of thrombolysis with a raised INR outweighs the potential benefits. However, documenting its use outside of the current eligibility criteria is key to future developments.
http://ift.tt/2eOFkIf
Paraurethral cysts in newborn girls
The Skene's glands are located in the distal urethral floor, and they are the largest paraurethral glands. Skene's gland cysts are unusual at any age, but specially newborns. However, due to lack of systematic reporting, true incidence is probably higher than the one described in the literature. We present a newborn girl found to have a paraurethral cyst at birth. Characteristic displacement of the urethral opening was revealed on catheterisation. Review of literature, and comparison to a similar case of interlabial mass previously evaluated, were carried out. We suggest a prenatal development possibly due to maternal oestrogen exposure, although further studies are necessary to determine the exact aetiology. Treatment options include observation, needle aspiration and incisional drainage, partial excision, unroofing and marsupialisation. Expectant management is preferred in asymptomatic cases, particularly in newborns, since spontaneous resolution can occur without long-term sequalae or recurrence. Cases with acute obstruction require immediate surgical management.
http://ift.tt/2erD0ci
Ventricular fibrillation via torsade des pointes of cardiac sarcoidosis with preserved left ventricular ejection fraction
Generally, low left ventricular ejection fraction (LVEF) is a risk for ventricular arrhythmia in patients with cardiac sarcoidosis. We present a case of cardiac sarcoidosis with preserved LVEF that evoked ventricular fibrillation (VF). A 73-year-old woman with VF presented to our emergency department. She had a history of ocular sarcoidosis, with gradual thinning of the basal intraventricular septum. LVEF was 62% on the most recent echocardiography. The electrocardiogram after defibrillation showed complete atrioventricular block (CAVB) with QT segment prolongation and frequent ventricular premature beats. VF via torsade des pointes (TdP) was suspected, and temporary intravenous ventricular pacing and magnesium sulfate infusion suppressed her VF. Cardiac sarcoidosis was diagnosed, and an implantable cardioverter defibrillator was implanted. Patients with cardiac sarcoidosis with CAVB are at risk of evoking VF via TdP regardless of LVEF. If cardiac sarcoidosis is suspected, early diagnosis and risk stratification of ventricular arrhythmia are important.
http://ift.tt/2eOGyTX
Urethral leiomyoma: a rare case of voiding difficulty
Description
A woman aged 28 years presented with a history of voiding difficulty with straining on micturition for 2 months. She was completely asymptomatic and had no symptoms of voiding difficulty prior to this. On physical examination, she was found to have a firm tender mass measuring 2.5x2 cm, involving the posterior periurethral region. The urethral orifice could not be separately identified. Uroflowmetry was performed and was within the normal limit. Transperineal ultrasound revealed a well-defined homogeneously hypoechoic solid lesion anterior to the vagina. The posterior urethral wall could not be separately delineated from the lesion. On colour Doppler interrogation, the lesion showed significant internal vascularity (figure 1). There was no significant postvoid residue. MRI was performed for further characterisation of the lesion and its relation to adjacent structures. Axial, coronal and sagittal T2-weighted, short tau inversion recovery (STIR) and precontrast and postcontrast T1-weighted images were acquired. A well-defined...
http://ift.tt/2erCDhV
Infant born with Robert's syndrome without prenatal care in a developing nation
Maternal and child well-being during pregnancy can be attributed to receiving optimal prenatal care. However, in developing nations, there are many barriers to receiving this. We present a primigravid female aged 29 years with severe abdominal pain. She was in active labour at 40 weeks and completely unaware of her pregnancy; hence, she did not receive any prenatal care. The baby was born with significant birth deformities that were consistent with Robert's syndrome. Although early detection could not preclude the development of this disorder, proper care would have facilitated in receiving genetic counselling and proper understanding of the prognosis. In this case, we discuss the various barriers to receiving prenatal care and measures taken for improvement in developing nations.
http://ift.tt/2eOG1kZ
Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases
This case report describes 2 cases of persistent urinary incontinence in the beginning of the learning curve of robot-assisted bladder neck implantation of an artificial urinary sphincter (RA-AUS) in men at risk for erosion due to neurological lesions. Among a series of 4 RA-AUS, 2 patients still experienced urinary incontinence after surgery. A complete urological workup was strictly normal and did not show any device malfunction. However, during an AUS revision in these two patients, exploration revealed that the cuff was not tight enough. This issue was resolved by placing smaller cuffs. After re-do surgery, one of the two patients no longer had urinary incontinence, while the second patient was lost to follow-up. Insufficient tightness of the cuff could be explained by an inability of the surgeon to feel the force while pulling the cuff around the urethra due to the absence of haptic sensation in robotic surgery.
http://ift.tt/2erEcML
Coronary artery bypass grafting with internal thoracic arteries may cause bilateral brachiocephalic vein occlusion, complicating pacemaker implantation
The number of patients with arrhythmia and ischaemic heart diseases is increasing. Patients with pacemaker implantation sometimes have brachiocephalic vein occlusion, and several aetiologies have been reported. However, coronary artery bypass grafting using the internal thoracic arteries is not fully discussed in the literature. We present a case of failed percutaneous pacemaker implantation due to bilateral brachiocephalic vein occlusion 8 years after coronary artery bypass grafting using the bilateral internal thoracic arteries. There were rich collateral veins consisting of hemiazygos and azygos veins. We then performed surgical implantation instead. Contrast CT or venography for such patients might be considered.
http://ift.tt/2eOBFtX
Visual disturbance with systemic symptoms: old lessons revisited
We describe a retired physician who presented with visual disturbance and systemic symptoms. The presence of general malaise, headache and scalp tenderness, with raised inflammatory markers, suggested that giant cell arteritis (GCA) was the likely diagnosis. Rapid response to initial steroid therapy and histological evidence of inflammation in the temporal artery supported this diagnosis. The character of these visual symptoms was, however, atypical for GCA. The patient, who had heart valve disease, subsequently deteriorated and developed further symptoms warranting investigation of bacterial endocarditis. Retinal emboli are a recognised complication of endocarditis, which could account for these visual symptoms. Moreover, interpretation of the temporal artery biopsy is limited in the context of existing steroid therapy. Our patient was consequently diagnosed with bacterial endocarditis. This case reminds us to consider the wider differential diagnoses for headache, visual disturbance and systemic symptoms, where echocardiogram and blood cultures may be crucial to reach the diagnosis.
http://ift.tt/2erD23U
Thiamine refractory Wernickes encephalopathy reversed with magnesium therapy
Description
A 34-year-old man was presented to our emergency department in alcohol withdrawal.
Despite initial treatment with high-dose intravenous thiamine therapy he went on to develop nystagmus (video 1), ataxia, pass pointing, intention tremor and worsening confusion. He was diagnosed with Wernickes encephalopathy, an acute neuropsychiatric syndrome resulting from thiamine deficiency.1
Video 1
Our patient demonstrates bilateral vertically upbeat nystagmus.
His serum magnesium levels were found to be low at 0.41 mmol/L (normal range 0.66–1.02 mmol/L). He was started on high-dose intravenous magnesium in addition to thiamine replacement and his neurological symptoms resolved once his serum magnesium levels had normalised (video 2).
Video 2
Our patient's nystagmus has improved, although a few beats remain at extreme lateral gaze.
He was discharged home and on review in clinic 4 weeks later, he had made a complete recovery.
Magnesium is an...
http://ift.tt/2eOEkE7
Where did the clot go? An unusual complication of mechanical thrombectomy caused by malignancy related subclavian steal phenomenon in a patient with acute basilar artery occlusion
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.
http://ift.tt/2erCyul
Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer
Hyponatremia (serum Na levels of
http://ift.tt/2eOyrqw
Pasteurella multocida Bacteremia in an Immunocompromised Patient
We present the case of a 61-year-old Caucasian gentleman who presented with a one-day history of fever, chills, and altered mental status. His symptoms were initially thought to be secondary to cellulitis. Blood cultures grew Pasteurella multocida, a rare pathogen to cause bacteremia. Our patient was treated with ciprofloxacin for two weeks and made a complete and uneventful recovery. Our patient's uncontrolled diabetes mellitus and chronic kidney disease put him at a higher risk for developing serious P. multocida infection. The patient's dog licking the wounds on his legs was considered as the possible source of infection. As P. multicoda bacteremia is rare, but severe with a high mortality rate, it is imperative to have a high index of suspicion for this infection especially in the vulnerable immunocompromised population.
http://ift.tt/2eOvaaQ
Risk factors for thoracic and spinal deformities following lung resection in neonates, infants, and children
Abstract
Purpose
We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection.
Methods
We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014.
Results
Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day–13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities.
Conclusions
Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.
http://ift.tt/2dFYXQs
Risk factors for thoracic and spinal deformities following lung resection in neonates, infants, and children
Abstract
Purpose
We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection.
Methods
We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014.
Results
Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day–13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities.
Conclusions
Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.
from Cancer via ola Kala on Inoreader http://ift.tt/2dFYXQs
via IFTTT
[Localized prostate cancer: Changes are still expected].
[Localized prostate cancer: Changes are still expected].
Bull Cancer. 2016 Oct;103(10):809-810
Authors: Vignot S, Bay JO, Massard C, Thariat J, Comité de rédaction
PMID: 27770995 [PubMed - in process]
from Cancer via ola Kala on Inoreader http://ift.tt/2fc21ct
via IFTTT
[Prevalence and management of pain in patients with metastatic cancer in Franche-Comté].
 | Related Articles |
[Prevalence and management of pain in patients with metastatic cancer in Franche-Comté].
Bull Cancer. 2016 Oct;103(10):849-860
Authors: Dénommé F, Kroemer M, Montcuquet P, Nallet G, Thiery-Vuillemin A, Bazan F, Mouillet G, Villanueva C, Demarchi M, Stein U, Almotlak H, Chaigneau L, Curtit E, Meneveau N, Maurina T, Dobi E, Hon TN, Cals L, Mansi L, Verlut C, Pana-Katatali H, Caubet M, Paillard MJ, Limat S, Pivot X, Nerich V
Abstract
INTRODUCTION: Pain management is a major public health problem, especially in oncology. In order to assess professional practice, the IRFC-FC conducted a survey amongst patients with metastatic osteophilic solid tumor in Franche-Comté. The aims were to assess the pain prevalence, and its characteristics, its management and its impact on patients' quality of life in patients in pain.
METHODS: An observational, prospective and multicenter survey was conducted using a self-report questionnaire. Patients with metastatic breast or prostate cancer managed in 5 day-hospitals of the IRFC-FC over a period of three months were included.
RESULTS: Two hundred thirty-three questionnaires were analyzed. Pain prevalence rate was 48.5%. Three quarters of patients in pain had chronic background pain, moderate to severe, with or without breakthrough pain. Considering their pain intensity and their analgesic therapy, 42.0% of patients seem to have an inadequate treatment. Eighty-five percent of treated patients reported to be compliant and felt that their pain was well managed despite a strong impact on their quality of life.
CONCLUSION: The setting of a specific clinical pathway is essential to secure the standardized, optimal and efficient management of patients in pain. The assessment of patient satisfaction and quality of life must be integrated in clinical practice to identify patients in pain for which the treatment is inappropriate.
PMID: 27692731 [PubMed - in process]
from Cancer via ola Kala on Inoreader http://ift.tt/2cPhr5K
via IFTTT
[Urinary incontinence and sexual dysfunction after treatment of localized prostate cancer: Results from a population aged less than 65years old].
| Related Articles |
[Urinary incontinence and sexual dysfunction after treatment of localized prostate cancer: Results from a population aged less than 65years old].
Bull Cancer. 2016 Oct;103(10):829-840
Authors: Bessaoud F, Orsini M, Iborra F, Rebillard X, Faix A, Soulier M, Daurès JP, Trétarre B
Abstract
INTRODUCTION: An increasing number of patients with prostate cancer (PC) are diagnosed and treated. The aim of this study was to investigate urinary incontinence (UI) and sexual dysfunction (SD) two years after treatment for localized prostate cancer (PC).
METHODS: This study followed all cases of localized PC diagnosed between 2008 and 2009 in men aged≤65years old and still alive two years after treatment. In total, 437 men were recruited. Data were collected using a standardized questionnaire and by cross-checking with data from the cancer registry. Descriptive and comparative analyses were performed to evaluate persisting UI and SD at 2years.
RESULTS: At two years after treatment, UI was persistent in 48.8%; 41.2% had used urinary protections, and 39.2% had used at least 1 pad/day; 55.2% reported financial difficulties for purchasing protective pads. In total, 22.7% did not consult a specialist for UI. SD was persistent in 82.8%; 30.4% did not consult a specialist for SD. SD had a negative impact on the sex life of patients and their partners. After adjustment for cancer stage, prostatectomy was significantly associated with persisting UI and SD at two years.
CONCLUSION: Two years after treatment, rates of persisting UI and/or SD remain high. Treatment by prostatectomy was significantly associated with an increased risk of persisting adverse effects at two years. The different toxicities between treatments should be presented to patients before initiating therapy in order to encourage the patient to contributed to shared treatment decision-making.
PMID: 27692730 [PubMed - in process]
from Cancer via ola Kala on Inoreader http://ift.tt/2fc0h38
via IFTTT
Active salvage chemotherapy versus best supportive care for patients with recurrent or metastatic squamous cell carcinoma of the esophagus refractory or intolerable to fluorouracil, platinum, and taxane
Abstract
Purpose
The survival benefit of chemotherapy (CTx) compared with best supportive care (BSC) is unclear in patients with recurrent or metastatic esophageal squamous cell carcinoma (R/M-ESCC) previously treated with fluorouracil (FU), platinum (PT), and taxane (TAX).
Patients and methods
The data of 283 consecutive patients with R/M-ESCC, who could not tolerate or whose tumor was refractory to all three agents (FU, PT, and TAX) between March 2003 and November 2014, were retrospectively reviewed. Patient selection criteria were as follows: age 20–75 years, performance status 0–2, and preserved organ function. Prognostic factors for overall survival (OS), defined as survival time from the last administration of all three agents, were analyzed using the Kaplan–Meier method and Cox proportional hazards model.
Results
Of the 283 patients, 147 received BSC and 136 received CTx (PT-containing regimen 37, investigative new drugs 28, irinotecan-containing regimen 29, TAX alone 25, FU alone 16, others 4). Most patients' tumors were refractory to all three agents. The median OS of BSC and CTx patients was 4.2 and 7.8 months (hazard ratio 0.41; 95% confidence interval 0.31–0.54), respectively. Multivariate analysis with or without propensity score matching indicated that BSC, metastatic sites other than lung, liver, or bone, and hemoglobin <10 g/dL were associated with poor prognosis.
Conclusion
CTx might provide a survival benefit over BSC even for patients with R/M-ESCC who cannot tolerate or whose tumor is refractory to all three agents.
from Cancer via ola Kala on Inoreader http://ift.tt/2eyYsy8
via IFTTT
Toxicity, pharmacokinetics and metabolism of a novel inhibitor of IL-6-induced STAT3 activation
Abstract
Purpose
The oncogenic transcription factor signal transducer and activator of transcription 3 (STAT3) promotes gene transcription involved in cancer, and its activation by IL-6 is found in head and neck squamous cell carcinoma. Four triazolothiadizine STAT3 pathway inhibitors were evaluated to prioritize a single compound for in vivo examination.
Methods
Metabolic stability in mouse liver microsome incubation was used to evaluate four triazolothiadizine analogues, and UPCDC-10205 was administered to mice IV as single or multiple doses to evaluate toxicity. Single-dose pharmacokinetics (PK), bioavailability and metabolism were studied after IV 4 mg/kg, PO 4 mg/kg, or PO 30 mg/kg suspension in 1% carboxymethyl cellulose. Mice were euthanized between 5 min to 24 h after dosing, and plasma and tissues were analyzed by LC–MS. Non-compartmental PK parameters were determined.
Results
Of the four triazolothiadizine analogues evaluated, UPCDC-10205 was metabolically most stable. The maximum soluble dose of 4 mg/kg in 10% Solutol™ was not toxic to mice after single and multiple doses. PK analysis showed extensive tissue distribution and rapid plasma clearance. Bioavailability was ~5%. A direct glucuronide conjugate was identified as the major metabolite which was recapitulated in vitro.
Conclusions
Rapid clearance of UPCDC-10205 was thought to be the result of phase II metabolism despite its favorable stability in a phase I in vitro metabolic stability assay. The direct glucuronidation explains why microsomal stability (reflective of phase I metabolism) did not translate to in vivo metabolic stability. UPCDC-10205 did not demonstrate appropriate exposure to support efficacy studies in the current formulation.
from Cancer via ola Kala on Inoreader http://ift.tt/2eELlaZ
via IFTTT