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Abstract This study aimed to perform a meta-analysis comparing the efficacy and safety of gefitinib in combination with chemotherapy versus gefitinib alone in patients with advanced Non-Small Cell Lung Cancer (NSCLC). We searched databases for clinical studies that reported the efficacy or safety of gefitinib plus chemotherapy in comparison with gefitinib alone. Raw data from included studies were extracted and pooled to calculate the Odds Ratio (OR) for Objective Response Rate (ORR) and Disease Control Rate (DCR), the Hazard Ratio (HR) for Progression-Free Survival (PFS) and Overall Survival (OS), and OR for complication ≥ Grade 3. A total of 10 studies containing 1,528 patients with NSCLC were identified and included in the analysis. Gefitinib plus chemotherapy showed significantly better efficacy in improving ORR (OR = 1.54; 95% CI [Confidence Interval], 1.13‒2.1; p = 0.006), DCR (OR = 1.62; 95% CI 1.14‒2.29; p = 0.007), PFS (HR=1.67; 95% CI 1.45‒1.94; p < 0.001) and OS (HR = 1.49; 95% CI 1.2‒1.87; p < 0.001) as compared with gefitinib alone. Consistent results were observed in the sub-population with positive EGFR mutation. The combination of gefitinib with chemotherapy had a significantly higher risk of complication (≥ Grade 3) with an OR of 3.29 (95% CI 2.57‒4.21; p < 0.001). The findings in the present study suggest that the combination of gefitinib with chemotherapy can provide better disease response and survival outcomes for patients with advanced NSCLC.
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Objective:To study the combined use of neoadjuvant chemotherapy and immunotherapy in patients with borderline resectable pancreatic cancer.Methods:The clinical data of patients with pancreatic cancer who were planned to undergo perioperative treatment before surgical treatment at the Fifth Medical Center of PLA General Hospital from January 2019 to June 2021 were retrospectively studied. Of 22 patients with pancreatic cancer, there were 10 males and 12 females, aged (56.0±10.2) years old. Preoperative treatment with chemotherapy (nab-paclitaxel and S-1, AS) and immunotherapy regimen before surgery were given. The baseline characteristics, treatment efficacy, surgical pathology and prognosis were analyzed.Results:Of 22 patients who were treated with neoadjuvant chemotherapy combined with programmed death-1 (PD-1) monoclonal antibody, 11 patients (50%) had tumors in the head, neck and uncinated process of pancreas. On radiographic assessment, one patient achieved CR (4.5%, 1/22), 9 patients PR (40.9%, 9/22), and 11 patients SD (50.0%, 11/22). All patients subsequently underwent R 0 resection. The postoperative pTNM staging showed 91% (20/22) of patients were in stage IA-IIB, 31.8% (7/22) of patients had pT2, 63.6% (14/22) had N0, and 1 patient had pCR. Thirteen patients (54.2%, 13/22) received postoperative adjuvant therapy. The median recurrence-free survival (RFS) was 6.4 months and the median time to progression (TTP) was 12.8 months. The median overall survival of patients was not reached. Postoperative pathology TNM staging IIA to III ( HR=3.63, 95% CI: 1.18-11.20, P=0.025) and postoperative pathology T2-3 stage ( HR=2.02, 95% CI: 1.01-5.05, P=0.049) were significantly associated with RFS. Postoperative pathology TNM stages IIA to III ( HR=2.39, 95% CI: 1.04-5.50, P=0.041) and postoperative pathology T2-3 stage ( HR=2.53, 95% CI: 1.26-5.09, P=0.009) were significantly associated with TTP. Conclusion:AS combined with PD-1 monoclonal antibody showed good efficacy as a neoadjuvant therapy for patients with borderline-resectable pancreatic cancer.
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Neoadjuvant chemotherapy (NAC) has shown promising results in patients with locally advanced penile cancer. However, no consensus exists on its applications for locally advanced penile cancer. Thus, it is unclear which kind of chemotherapy regimen is the best choice. Consequently, a systematic search of PubMed, Web of Science, and EMBASE was performed in March 2021 to assess the efficacy and safety of NAC for the treatment of patients with locally advanced penile cancer. The Newcastle-Ottawa Scale was used to assess the risk of bias in each study. This study synthesized 14 published studies. The study revealed that patients who achieved an objective response to NAC obtained a better survival outcome compared with those who did not achieve an objective response. In addition, the objective response rates (ORRs) and pathological complete response (pCR) rates were 0.57 and 0.11, respectively. The incidence of grade ≥3 toxicity was 0.36. Subgroup analysis found that the ORR and pCR of the taxane-platinum (TP) regimen group performed better than those of the nontaxane-platinum (NTP) regimen group (0.57 vs 0.54 and 0.14 vs 0.07, respectively). Moreover, the TP regimen group had more frequent toxicity than the NTP regimen group (0.41 vs 0.26). However, further studies were warranted to confirm the findings.
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Humans , Male , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoadjuvant Therapy/methods , Penile Neoplasms/drug therapy , Platinum , Treatment OutcomeABSTRACT
Introduction: Concurrent chemo-radiation is the standard ofcare for locally advanced head and neck carcinoma. Duringlater part of radiation treatment schedule, there is acceleratedrepopulation of surviving tumour cells. So the treatment shouldbe completed as early as possible. Study aimed to comparethe loco-regional control rates between the acceleratedfractionated and conventional fractionated radiotherapy andto compare the rate of acute and late toxicities between thetwo arms.Material and Methods: Thirty patients with locally advancedhead and neck cancer in the study arm (ARM-A) received sixfractions of radiotherapy per week and thirty-two patients in thecontrol arm (ARM-B) received five fractions of radiotherapyper week. Total radiation dose was same in both arms. Inj.Cisplatin at a dose of 100mg/m2 was given to the patients ofboth the arms every three weeks as a radiosensitizer agent.Results: Complete response rate (19/30 vs 14/32) rate thoughhigher in the study arm, was not statistically significant.Similarly overall response rate (25/30 vs 21/32) was notstatistically significant (P value – 0.15). Among acutetoxicities only dysphagia was significantly higher in the studyarm (P value-0.024). Late toxicities were similar in both thearms.Conclusion: So accelerated fractionation radiotherapy canbe used for treating locally advanced head and neck cancerpatients to improve loco-regional control rate with acceptabletoxicities.
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Introduction: Gastric cancer is the second leading cause ofcancer death worldwide, with a 5-year survival rate of lessthan 20%. About 25% of patients with gastric cancer presentwith disseminated disease and more than half of those withapparently localized disease recur within 5 years. Study aimedto evaluate the response rate, median PFS, overall survivaland toxicity to 3 Weekly Cisplatin/5-Fluorouracil Vs Weekly5-Fluorouracil in patients with advanced gastric cancer.Material and Methods: Patients were recruited forchemotherapy with Cisplatin 75mg/mg2 in divided dosesand 5-Fluorouracil 750mg/m2 for 3 days in every 21 daysfor 6 cycles in one arm and 20 patients for treatment withWeekly 5- Fluorouracil 500mg for 16 weeks. Within twomonths of completion of chemotherapy, CT abdomen wasdone to compare with the baseline CT abdomen to assess theresponse rate using RESIST criteria Version V1.1. Also theimprovement in ECOG PS was ascertained as an endpoint.Results: In the Cisplatin /5FU arm had an overall response rateof 20%, median PFS of 6 months,45% had a partial response(PR), 10% had stable disease (SD) 25% had progression(PD), 20% achieved CR and more of haematological andnon-hematological toxicity. In the 5FU arm, 35% had stabledisease (SD),40% had progression (PD) 5% achieved CR andless of haematological and non-hematological toxicity.Conclusion: In advanced gastric cancer, Cisplatin /5FU hadmore response rate, more median PFS and more toxicity.Weekly 5FU is better tolerable regimen with
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Objective: To observe the clinical efficacy and safety of apatinib combined with chemotherapy in the patients with advanced breast cancer after failed multi-line therapy, and to clarify the siginificance of apatinib in the treatment of the patients with advanced breast cancer. Methods: Twenty-five patients with advanced breast cancer were treated with multi-line therapy, among them 5 (20%) patients were in the third-line treatment, 7 (28%) patients were in the fourth-line treatment, and 13 (52%) patients were in the fifth-line treatment and above. All patients were treated with apatinib in combination with chemotherapy, and the chemotherapy regimen was selected based on the condition and previous medication. Apatinib 250-500 mg was given orally once a day, until the disease progresses occured or the patients could not tolerate the adverse reactions. The efficacies, including the objective response rate (ORR), the clinical benefit rate (CBR), and progression-free survival (PFS), were evaluated by RECIST 1. 1. The adverse reactions were evaluated by NCI-CTC 4. 0. Results: The median number of treatment lines of the patients with breast cancer was fifth-line, the total ORR was 12% (3/25), the CBR was 52% (18/25), and the median progression-free survival (mPFS) was 6. 00 months. Among the 5 patients with third-line therapy, 2 patients were stable disease (SD) and the CBR was 40% (2/5); among the 7 patients received the fourth-line therapy, 2 patients were partial response (PR), 2 patients were SD, and the CBR was 57% (4/7); among the 13 patients received firth-line therapy, 1 patient was PR, 6 cases were SD, and the CBR was 54% (7/13). According to the pathological type, among 5 patients of triple-negative type, 3 patients were SD, the CBR was 60% (3/5); among 12 patients of Luminal type, 1 patients was PR, 2 patients were SD, and the CBR was 25% (3/12); among 8 patients of HER-2 positive type, there were 2 patients acheived PR, 5 patients acheived SD, and the CBR was 88% (7/8). The short-term efficacy of the patients in 50 years old and over group was better than that of the patients in below 50 years old group (P<0. 05). There were no significant differences in the short-term efficacies between the other factors (PX). 05). Moreover, the patients treated with apatinib combined with chemotherapy had good tolerance, and the main adverse reactions were fatigue, hand-foot syndrome, hepatic insufficiency, hypoproteinemia, anemia, anepi-thymia, hypertension, and proteinuria; mainly in grade 1 or grade 2; the most common adverse reactions were fatigue (80%), hypoproteinemia (60%), hand-foot syndrome (60%), and hepatic insufficiency (60%). Conclusion: Apatinib mesylate combined with chemotherapy is effective in the treatment of the advanced breast cancer patients failed in multi-line therapy and the patients can tolerate the adverse reactions.
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ABSTRACT OBJECTIVE To describe the response rate and characteristics of people who either took part or not in from the Study of Cardiovascular Risks in Adolescents (ERICA) , according to information subsets. METHODS ERICA is a school-based, nation-wide investigation with a representative sample of 12 to 17-year-old adolescents attending public or private schools in municipalities with over 100,000 inhabitants in Brazil. Response rate of eligible subjects were calculated according to macro-regions, sex, age, and type of school (public or private). We also calculated the percentages of replacement schools in comparison with the ones originally selected as per the sample design, according to the types of schools in the macro-regions. The subjects and non-subjects were compared according to sex, age, and average body mass indices (kg/m2). RESULTS We had 102,327 eligible adolescents enrolled in the groups drawn. The highest percentage of complete information was obtained for the subset of the questionnaire (72.9%). Complete information regarding anthropometric measurements and the ones from the questionnaire were obtained for 72.0% of the adolescents, and the combination of these data with the 24-hour dietary recall were obtained for 70.3% of the adolescents. Complete information from the questionnaire plus biochemical blood evaluation data were obtained for 52.5% of the morning session adolescents (selected for blood tests). The response percentage in private schools was higher than the one in public schools for most of the combination of information. The ratio of older and male adolescents non-participants was higher than the ratio among participants. CONCLUSIONS The response rate for non-invasive procedures was high. The response rate for blood collection – an invasive procedure that requires a 12-hour fasting period and the informed consent form from legal guardians – was lower. The response rate observed in public schools was lower than in the private ones, and that may reflect lower school frequency of registered students.
RESUMO OBJETIVO Descrever o percentual de resposta e características de participantes e não-participantes no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) segundo subconjuntos de informações. MÉTODOS O ERICA é um inquérito de base escolar de abrangência nacional com amostra representativa de adolescentes, de 12 a 17 anos de idade, que estudam em escolas públicas ou privadas de municípios com mais de 100 mil habitantes de todo o Brasil. Foram calculadas frequências de participação (de elegíveis) por macrorregiões, sexo, idade, e tipo de escola (pública ou privada). Foram calculados também os percentuais de escolas substitutas das selecionadas na origem do desenho amostral, de acordo com o tipo de escola nas macrorregiões. Os participantes e não-participantes foram comparados segundo sexo, idade e média de índice de massa corporal (kg/m2). RESULTADOS Estavam cadastrados nas turmas sorteadas 102.327 adolescentes elegíveis. O maior percentual de informações completas foi obtido para o subconjunto do questionário (72,9%). Informações completas das medidas antropométricas e do questionário foram obtidas em 72,0% dos adolescentes, e a combinação dessas informações com recordatório alimentar de 24h, em 70,3%. Informações completas do questionário mais avaliação bioquímica do sangue foram obtidas em 52,5% dos adolescentes do turno da manhã (elegíveis para exame de sangue). O percentual de resposta nas escolas privadas foi maior do que a das escolas públicas para a maioria das combinações de informações. A proporção de adolescentes não participantes do sexo masculino e mais velhos foi maior do que entre os participantes. CONCLUSÕES O percentual de resposta para procedimentos não invasivos foi elevado. Para a coleta de sangue, procedimento invasivo, com necessidade de jejum de 12 horas e de consentimento escrito dos responsáveis, a participação foi menor. O percentual de participação observado nas escolas públicas foi menor do que nas particulares, podendo refletir menor frequência escolar dos alunos cadastrados.
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Humans , Male , Female , Adolescent , Cardiovascular Diseases/epidemiology , Surveys and Questionnaires , Health Surveys , Schools/statistics & numerical data , Socioeconomic Factors , Students/statistics & numerical data , Brazil/epidemiology , Anthropometry , Risk FactorsABSTRACT
Objective To evaluate the safety and preliminary efficacy of mFOLFOXIRI (the combination of irinotecan, oxaliplatin and 5-fluorouracil with reducing dosages) in first-line treatment for Chinese patients with unresectable metastatic colorectal cancer (mCRC). Methods A total of 21 patients received mFOLFOXIRI treatment: irinotecan 150mg/m2 on day 1, oxaliplatin 85mg/m2 on day 1, leucovorin 200mg/m2 on day 1, and 5-fluorouracil (5-FU) 2800mg/m2 in a 48-h continuous infusion starting on day 1. The regimen was repeated every 2 weeks. Result All the 21 patients were evaluated for efficacy of the aforesaid therapeutic regimen, and the incidence of toxic effects. No death occurred in association with the treatment. The total rate of grade 3 to 4 adverse events was 42.9% (9/21) including 38.1% (8 cases) with grade 3 neutropenia and 4.8% (1 case) suffering from grade 3 anemia. One of 21 patients (4.8%) showed grade 4 neutropenia accompanied by fever. The delivered relative dose intensity of irinotecan, oxaliplatin and 5-FU during the entire treatment course were 93.4%, 98.5% and 97.6%, respectively of planned dosage. In the intention-to-treat analysis for treatment activity, 14 patients showed remission, 6 stability, and 1 with progression of the disease. The overall response rate was 66.7%, and the disease control rate was 95.2%. Three patients (15.8%) with residual liver metastases were radically resected after mFOLFOXIRI chemotherapy. Conclusions This mFOLFOXIRI project has manageable toxicity and is well tolerated in Chinese patients. The safety profile appears to be improved compared with standard FOLFOXIRI regimen. In addition, the antitumor activity and preliminary efficacy seem to be maintained.
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Objective To measure the erythrocyte dielectric response variation of patients with KaschinBeck disease,to explore the pathogenesis of Kaschin-Beck disease and seek more effective means for evaluating the effectiveness of early diagnosis and control measures against Kaschin-Beck disease.Methods According to the principle of dielectrophoresis and cell dielectric response phenomena,dielectrophoretic pool was manufactured and dielectrophoretic detection and separation system was established.Patients with Kaschin-Beck disease (438) were selected in Kaschin-Beck disease areas of Aba County,Sichuan.At the same time,healthy persons (480) in KaschinBeck disease areas and non-Kaschin-Beck disease areas in Aba County were selected.Anticoagulant blood samples from patients with Kaschin-Beck disease and healthy persons were collected,erythrocytes were separated,cell suspension (10s cells/ml) was prepared and 200 μl cell suspension was added to the dielectrophoretic pool to measure erythrocyte dielectric response rate.Results Erythrocyte dielectric response rates were significantly different between patients living in Kaschin-Beck disease areas with Kaschin-Beck disease [(75.87 ± 5.89)％] and healthy persons living in Kaschin-Beck disease areas and non-Kaschin-Beck disease areas [(92.43 ± 4.45)％,(92.81 ±5.01)％,F =1.843,P ＜ 0.01).Erythrocyte dielectric response rate was significantly reduced in patients with Kaschin-Beck disease compared with that of healthy persons (all P ＜ 0.01);erythrocyte dielectric response rate of adult patients with Kaschin-Beck disease was lower [(69.57 ± 6.87)％] than that of pediatric patients with Kaschin-Beck disease [(82.17 ± 4.91)％,P ＜ 0.01].Erythrocyte dielectric response rates were significantly different in patients with different degrees of Kaschin-Beck disease (F =1.647,P ＜ 0.01).Erythrocyte dielectric response rate of patients with Kaschin-Beck disease was negatively correlated with prevalence of the disease (r =-0.87,P ＜ 0.01).Conclusions Erythrocytes of patients with Kaschin-Beck disease have some degree of pathological damage.The more severe the disease,the more serious the damage of red blood cell.The change of erythrocyte dielectric response properties may be used as an index to judge the prevalence of Kaschin-Beck disease and for early diagnosis.
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Background: Carcinoma cervix is the second most common malignancy among females of India (1). The low incidence rate in developed countries is because of well-developed screening programs and awareness among women. But in developing countries like India, because of lack of health awareness and lack of proper screening facilities, patients usually present in advanced stages. They also have a lot of associated co-morbidities like obstructive uropathy with or without deranged RFT, anaemia, poor nutrition, tuberculosis, diabetes, hypertension, multiple genital infections etc. The standard treatment of advanced carcinoma cervix is radiotherapy with weekly cisplatin as radio-sensitizer but it has been observed that a lot of patients are not able to tolerate toxic side effects of concurrent chemo radiotherapy. Methods: We have chosen only one co-morbid condition i.e. obstructive uropathy with or without deranged RFT because of small sample size. So the aim of this study was to compare the compliance and response rate of concurrent chemo radiotherapy versus radiotherapy alone in patients of locally advanced carcinoma cervix having obstructive uropathy with or without deranged RFT. Results: Only 36% (n=9) patients in the RT+CT group received the complete planned five cycles of weekly cisplatin. Average number of cycles of cisplatin missed in the chemo-radiotherapy group was one (range 0-3). Compliance was better in the RT alone group. The average time in the RT alone group to complete radiotherapy was 57.72 days and in RT+CT group was 60.72 days. In the RT alone group the treatment time was prolonged by an average of 1.72 days (range 3-6) while in the CT+RT group it was prolonged by 4.72 days (range 2-14). Conclusions: It is hereby concluded that radiotherapy alone for locally advanced squamous cell cervical carcinoma patients having associated co morbid conditions like deranged RFT had a better compliance then with the concurrent chemoradiotherapy regime.
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Objective To evaluate the predictive effect of baseline hepatitis B surface antigen (HBsAg)on virological response in HBeAg -positive chronic hepatitis B patients treated with pegylated interferon (PEG -IFN ) α-2b. Methods The retrospective analysis compared the treatment efficacy of PEG -IFN α-2b in 55 cases of HBeAg -positive chronic hepatitis B patients with different baseline HBsAg levels.Serum HBV DNA load was measured at baseline and after 1 2,24,and 48 weeks of the therapy.Virological response was defined as HBV DNA <1 000 IU /ml.Serum HBsAg titers were quantitatively assayed at baseline,1 2 and 24 weeks.Results 1 8 patients had baseline HBsAg levels greater than 20 000 IU /ml(Group A),26 patients had baseline HBsAg levels between 1 500 and 20 000 IU /ml(Group B)and 1 1 patients had baseline HBsAg levels less than 1 500 IU /ml(Group C)after 48 weeks treatment with PEG -IFNα-2b.The achieved virological response rates of the three groups were 1 6.67%,42.31 % and 63.64% respectively with a statistically significant difference between group A and C (P <0.05).1 3 patients had HBsAg levels declined greater than 0.5 log1 0 and 30 patients had HBsAg levels declined less than 0.5 log1 0 at week 1 2 and the achieved virological response rates were 1 6.67%,46.2% and 33.3% respectively without statistically significant difference (P >0.05).1 6 patients with HBsAg <br> levels greater than 20 000 IU /ml after treatment of 24 weeks did not achieve virological response after treatment of 48 weeks.Conclusion Baseline HBsAg levels in combination with HBV DNA quantitative value may become an effective predictor for guiding optimal therapy with PEG -IFN α-2b against HBeAg -positive chronic hepatitis B.
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Objective To analyze the telephone follow-up response rate and related factors in lung cancer patients thus to explore the countermeasures to increase the telephone response rate.Methods One thousand six hundred and eight post-surgery lung cancer patients were followed up by telephone interview,calculate response rates and analyze the impact factors on response rates of surgical patients. Results The lung cancer patients' overall response rate of one thousand six hundred and eight cases was 83.1%.Reservation phone type, phone number,family history of cancer are major factors affecting lung cancer patients' telephone followed up response rate(P<0.05). Conclusions Telephone follow-up of patients with lung cancer response rates is at a low level.To improve tumor response rates of follow-up and follow-up quality is a long and arduous task,requiring medical personnel continue to learn professional knowledge,summing up a reasonable follow-up methods,but also needing patients and their families to understand and cooperate.
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BACKGROUND/AIMS: This study reports treatment outcomes after helical intensity-modulated radiotherapy (IMRT) in unresectable hepatocellular carcinoma (HCC) patients for whom transarterial chemoembolization (TACE) was considered ineffective or unsuitable. METHODS: From January 2008 to December 2011, 22 unresectable HCC patients received helical IMRT. A daily dose of 1.8 to 4 Gy was delivered at five fractions per week to deliver a total dose of 30 to 60 Gy. The most-prescribed dose fractionation was a total dose of 50 to 57.5 Gy, with a daily dose of 2.3 to 2.5 Gy. RESULTS: In the entire group, the objective response rate of the primary tumor was 72.7%. In the eight patients with portal vein thrombosis (PVT), the objective response rate of PVT was 50.0%. Median disease progression-free survival was 11.8 months, and the 1-year disease progression-free survival rate was 40.2%. The median overall survival was 14.4 months, and the 1- and 2-year overall survival rates were 86.4% and 69.1%, respectively. PVT and Child-Pugh classifications were significant prognostic factors for overall survival in multivariate analyses. CONCLUSIONS: Helical IMRT in patients with unresectable HCC resulted in high treatment response and survival rates. This study suggests helical IMRT is a practical treatment option for HCC patients in whom TACE is unsuitable or ineffective.
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Humans , Carcinoma, Hepatocellular , Disease-Free Survival , Dose Fractionation, Radiation , Portal Vein , Radiotherapy, Intensity-Modulated , Survival Rate , ThrombosisABSTRACT
Background:Although blood transfusion is a life saving therapy, it is associated with various ill effects, which can cause increased morbidity and mortality in recipients. Testing of all donated blood for transfusion transmitted infections (TTIs) such as HIV I & II, hepatitis B, hepatitis C and syphilis is one of the strategies recommended by WHO to ensure safe blood. However, if the donor is already having an infection, transmissible by blood, the transfusion will be rather hazardous for the recipient. The national blood policy of India 2002 advocates the disclosure of results of transfusion transmitted infections (TTIs) to blood donors. Aim:To assess the attitude of the transfusion transmitted infections (TTIs) reactive blood donor in response to the post-donation calls from blood bank. Material and methods: A total of 20865 blood donors came to the department of IHBT in period of one year from 1St November 2009 to 31St October 2010.All donated blood was screened against HIV I & II , Hepatitis B, hepatitis C and syphilis and malaria. On screening the units, it was found that 391 donation units (1.874 %) were positive for one of the TTIs, namely HIV I & II, HBsAg, HCV or syphilis. As follow-up, these donors were recalled at blood bank by a phone call. Results: out of 391 reactive donors only 236 responded to call (average response rate was 60.36%). Conclusion: The study suggest that authorities should frame some guidelines and rules that can increase the response rate among reactive donors and make them assessable because it enables their future investigation and treatment and the prevention of diseases transmission to the community.
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Objective The purpose of this study is to determine the outcome of patients with acne vulgaris treated with oral isotretinoin from January 2003 till January 2008. Methodology This is a 5-year retrospective study of patients with acne vulgaris who were started on oral isotretinoin from January 2003 to January 2008. Only patients who have completed at least 4 months of treatment were included. Case notes were retrieved and analyzed with regards to demographic data, total cumulative dose of oral isotretinoin, duration of treatment, average daily dose of isotretinoin, response, relapse and subsequent treatment. Patients who defaulted follow-up were contacted via phone to ascertain if they had any relapse. Laboratory data that were analyzed included serial liver enzymes, total cholesterol, triglyceride and LDL levels. Results A total of 110 case notes were reviewed but only 83 patients fulfilled the inclusion and exclusion criteria. Average daily dose of isotretinoin was 0.24 mg /kg/day and mean duration of treatment was 9.56 months. Mean total accumulated dose of isotretinoin was 61.96 ± 34.15 mg/kg (range from 11.18 mg/kg to 151.79mg/kg). There were only 6 (7.2%) patients who achieved total accumulated dose of more than 120mg/kg/day. All of our patients responded to treatment with 24 (28.9%) of them were in complete clearance. However, a high percentage (71.2%) of patients developed mucocutaneous side-effects out of which 27.7% required dose reduction. Relapse rate among those who completed treatment and follow up or contactable for at least 6 months post treatment was 24.2% (8 out of 33 patients). There were only 3 (3.6%) patients who developed raised transaminases during treatment but all were less than twice the upper normal limit. Mean total cholesterol, triglyceride and LDL level were significantly raised at 4 months of treatment when compared to the baseline (p<0.05). Conclusion Low dose Isotretinoin (<0.5mg/kg) is an effective treatment for moderate to severe acne vulgaris in our population. All of our patients showed good response to isotretinoin even though some of them relapsed subsequently. Intolerability as a result of mucocutaneous side-effects seems to be a challenging issue when starting isotretinoin in our population.
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PURPOSE: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. MATERIALS AND METHODS: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. RESULTS: The patients had a median age of 53 years (range: 19~75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5~83.3) after CCRT and followed by adjuvant chemo-therapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9~90.5) and 54.2% (95% CI: 36.7~71.7), respectively (p= 0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1+/-2.9 weeks vs. 9.0+/-1.2 weeks, p= 0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p= 0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). CONCLUSIONS: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.
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Humans , Anorexia , Appointments and Schedules , Chemoradiotherapy , Cisplatin , Nasopharyngeal Neoplasms , Nausea , Retrospective Studies , Saints , Treatment Outcome , VomitingABSTRACT
PURPOSE: There are questions about selecting the best postoperative chemotherapeutic regimen for breast cancer patients who have different response rates after neoadjuvant chemotherapy. The aim of this study was to examine the pathologic findings of residual tumors according to the response rate after neoadjuvant chemotherapy for breast cancer. METHODS: We obtained specimens of residual tumors from 43 breast cancer patients who received neoadjuvant chemotherapy followed by curative operation at the Department of Breast and Endocrine Surgery, Sacred Heart Hospital, between Oct. 2002 and Oct. 2006. Four patients received 3 cycles of FAC (5-FU, Adriamycin, Cyclophosphamide) and 39 patients received 3 cycles of AT (Adriamycin, Docetaxel). We analyzed the pathologic characteristics according to the response rate. RESULTS: The clinical response rate for neoadjuvant chemotherapy was 69.8%. There was no significant difference in the response rate for neoadjuvant chemotherapy between the AT and the FAC regimen groups. The tumors of the complete response group showed to be more ER-negative, PR-positive, p53-negative and c-erb-B2-positive and they had a lower Ki-67 staining index than the tumors of the partial response group. Moreover, the tumors of the clinical complete response group showed more triple (ER/PR/c-erb-B2) negative tumor than did the tumors of the partial response group. CONCLUSION: Although the tumor responded to neoadjuvant chemotherapy, the pathologic findings of the residual tumors in the clinical complete response group differed from that of the partial response group. So, this should be considered for the selection of postoperative chemotherapeutic agents.
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Humans , Breast , Breast Neoplasms , Doxorubicin , Heart , Neoplasm, ResidualABSTRACT
PURPOSE: The objective of this study was to test the efficacy and toxicity of adriamycin plus docetaxel as the primary chemotherapy for women with advanced breast carcinoma, and including those patients with inflammatory breast cancer. Our study also evaluated the clinicopathologic factors influencing the response rate to neoadjuvant chemotherapy. METHODS: Twenty-eight patients who underwent neoadjuvant chemotherapy between 2002 and 2004 were included for this study. The patients were treated with adriamycin (50 mg/m2; intravenous bolus) followed by docetaxel (75 mg/m2; 1-hr intravenous infusion) on the first day of each cycle for an average four cycles. We analysed the response rate to adjuvant chemotherapy by reviewing the post operative pathologic report. Additionally we compared the clincopathologic factors related to the response rate. Statistical analyses were performed with 2-tests and using SPSS 11.0. RESULTS: The mean age at diagnosis was 48.9 yr old (range 29-63 yr). The tumoral response to neoadjuvant chemotherapy was, 3 patients (10.7%) showed a complete response (CR), 21 patients (75%) showed a partial response (PR). and which about lymph node were that 15 patients (75%) have shown responder, 5 patients (25%) have shown non-responder. The overall response rate to neoadjuvant chemotherapy was 85.7%. The preoperative serum-CEA level was influenced the response rate to neoadjuvant chemotherapy (p=0.025). Grade 3 or 4 neutropenia was recorded in 81.9% of the patients (N=59/72). Grade 3 or 4 anemia was recorded in 2.8% of the patients. CONCLUSION: Neoadjuvant chemotherapy with adriamycin plus docetaxel was effective treatment for patients with locally advanced breast cancer. The preoperative serum CEA level colud be the important factor for the neoadjuvant chemotherapy response rate.
Subject(s)
Female , Humans , Anemia , Breast , Breast Neoplasms , Chemotherapy, Adjuvant , Doxorubicin , Inflammatory Breast Neoplasms , Lymph Nodes , Neutropenia , TaxoidsABSTRACT
BACKGROUND: Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short-term effects of inhaled corticosteroid on chronic cough METHODS: Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler 800 microgram/day for ten days. The primary outcome measure was a decrease in the cough score after treatment. RESULTS: Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment. CONCLUSION: Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.
Subject(s)
Humans , Asthma , Bronchial Provocation Tests , Bronchitis , Budesonide , Cough , Diagnosis , Eosinophils , Gastroesophageal Reflux , Inflammation , Methacholine Chloride , Outcome Assessment, Health Care , Radiography, Thoracic , Respiratory Function Tests , Respiratory Sounds , Sinusitis , SputumABSTRACT
The growing knowledge of cancer immunology during the past 20 years has led to the current implementation of immunotherapy. Immuno-cell therapy, in which ex vivo processed T lymphocytes and dendritic cells are used as agents, has developed and spread and is now accepted as a common treatment with the identification of a number of cancer peptide antigens. The response rate to immuno-cell therapy is reported to be around 10-20%. Some clinical studies have reported that immuno-cell therapy as a postoperative adjuvant therapy improved survival rates. This paper outlines the historic background and the current medical scene of immuno-cell therapy.<br>