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Abstract Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that acts on the activity of the cerebral cortex employing electrical currents. Aim: The objective of this project is to evaluate the effectiveness of rTMS on pain and quality of life in patients with chemotherapy-induced peripheral neuropathic pain. Method: Ten patients with chemotherapy-induced peripheral neuropathic pain received 20 sessions of rTMS, consisting of 15 minutes of treatment repeated 5 times per week for four weeks (10 Hz, 20s, 30 trains with 81% intensity). Patients were evaluated using the Brief pain inventory (BPI) and the Functional Assessment of Cancer Therapy and neurotoxicity (FACT-GOG-NTX 13). Results: There were significant differences in BPI mean severity, interference score and FACT-GOG-NTX 13 (p<0,05). Conclusion: The pilot study results suggest that rTMS is potentially beneficial for the treatment of chemotherapy-induced peripheral neuropathy. rTMS over the M1 had an important reduction in pain severity, interference with daily activities, and quality of life scores. However, results should be taken with caution due to the small sample size, absence of a control group and short period of follow-up.
Resumen Antecedentes: La estimulación magnética transcraneal repetitiva (EMTr) es una técnica no invasiva que actúa sobre la actividad de la corteza cerebral, empleando corrientes eléctricas. Objetivo: El objetivo de este proyecto es evaluar la eficacia de la EMTr sobre el dolor y la calidad de vida en pacientes con dolor neuropático periférico inducido por quimioterapia. Métodos: Diez pacientes con dolor neuropático periférico inducido por quimioterapia recibieron 20 sesiones de EMTr que consistieron en un tratamiento de 15 minutos repetido 5 veces por semana durante cuatro semanas (10 Hz, 20 s, 30 trenes con 81 % de intensidad). Los pacientes fueron evaluados mediante el Inventario Breve de Dolor (BPI) y la Evaluación Funcional de la Terapia del Cáncer y la neurotoxicidad (FACT-GOG-NTX 13). Resultados: Hubo diferencias significativas en la severidad media del dolor del BPI, la puntuación de interferencia y el FACT-GOG-NTX 13 (p<0,05). Conclusión: Los resultados del estudio piloto sugieren que la rTMS es potencialmente beneficiosa para el tratamiento de la neuropatía periférica inducida por la quimioterapia. La rTMS sobre M1 tuvo una reducción importante de la severidad del dolor, la interferencia con las actividades diarias y las puntuaciones de calidad de vida. Sin embargo, los resultados deben tomarse con cautela debido al pequeño tamaño de la muestra, la ausencia de un grupo de control y el corto período de seguimiento.
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This case report documents a woman in her sixties who initially presented with cardiac symptoms such as heart palpitations, shortness of breath, and fluctuating blood pressure. Following her hospital admission, she received a diagnosis of paroxysmal atrial fibrillation and underwent successful electrical cardioversion. Despite this intervention, her symptoms persisted, necessitating radiofrequency ablation of the Cavo-tricuspid isthmus, which proved to be highly effective. Subsequent diagnostic testing revealed the presence of coronary artery disease, atherosclerotic cardiosclerosis, and mitral valve abnormalities, all of which were managed appropriately. Upon discharge, the patient was prescribed a medication regimen comprising anticoagulants, hypotensive therapy, and statins, which she tolerated well. However, her symptoms deteriorated, leading to a referral to a specialized center where she was promptly diagnosed with cardiac amyloidosis (CA) and received appropriate treatment. Adjustments to her treatment plan were made based on this diagnosis, and a cardiac MRI confirmed the presence of amyloidosis. A biopsy of the buccal mucosa further confirmed the presence of AL-amyloidosis based on immunohistochemistry test results. The patient commenced chemotherapy, which unfortunately led to kidney damage but ultimately resulted in significant improvement in her condition. Recurrent atrial fibrillation episodes necessitated further interventions, which were performed swiftly and effectively. Multi-organ assessments revealed numerous abnormalities, guiding tailored management strategies. A multidisciplinary team comprising cardiology, hematology, and general practice specialists coordinated the patient's care, focusing on pharmacotherapy and lifestyle modifications, which were found to be highly effective. Emphasis was placed on continuous monitoring and adherence to treatment plans for long-term management, resulting in positive outcomes.
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Dysgerminoma is a malignant germ cell tumour (GCT) accounting for less than 1% of ovarian neoplasm. It is analogous to seminoma in males. It is a tumour of young age, affecting women of reproductive age group. In most of the cases, due to its clinical features of it is often, misdiagnosed as abdominal tuberculosis. It is one of the rare tumours, which have excellent response to chemotherapy and radiotherapy. It is tumour in whom, surgery followed by radiotherapy and chemotherapy gives excellent prognosis even in advanced stage. This is a rare case report of 16-year-old girl with primary amenorrhoea, abdominal mass and pleural effusion, when undergone staging laparotomy � had ovarian tumour with torsion which histopathologically came out to be, dysgerminoma.
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Cancer treatment during childhood, including head and neck radiotherapy and chemotherapy, can cause persistent dental and maxillofacial changes, which may lead to long-term complications in dental care and oral rehabilitation. Objective: The aim of this study was to evaluate dental and maxillofacial alterations resulting from childhood head and neck cancer treatment and discuss considerations regarding dental care for these patients. Methods: This retrospective study utilized a Cancer Center database, including patients referred to the Stomatology Department from 2004 to 2018. Results: The sample comprised 12 patients (7 males and 5 females) with a mean age of 5 years at diagnosis, who underwent oncological treatment in the head and neck region. Half exhibited facial bone hypoplasia, predominantly mandibular (33.33%) over maxillary (16.67%). Nearly all patients showed dental abnormalities, including agenesis (50%), supernumerary teeth (16.67%), and root formation anomalies (66%). Conclusion: This study underscores the importance of understanding these treatment-related alterations to ensure appropriate dental care for these patients. The involvement of a dental surgeon is crucial to providing comprehensive care and effectively monitoring any dental and maxillofacial complications. (AU)
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Humans , Male , Female , Child , Child , Maxillofacial Abnormalities , Radiotherapy , Drug Therapy , Cancer SurvivorsABSTRACT
En la actualidad, más de la mitad de las pacientes con cáncer de mama receptor hormonal positivo recibe algún esquema de quimioterapia adyuvante. Sin embargo, sólo algunas de ellas obtendrían un beneficio real en términos de sobrevida. Las plataformas genómicas permiten un mejor entendimiento de la heterogeneidad tumoral entre carcinomas con receptores hormonales positivos, Her2 negativos, habiendo sido validadas como herramientas para identificar aquellas. pacientes que obtendrían un beneficio claro con el tratamiento quimioterápico. El objetivo de nuestro estudio es describir el uso de la plataforma genómica Oncotype Dx® y evaluar su impacto sobre la indicación del tratamiento adyuvante, evaluado principalmente a través del cambio de conducta en relación con la indicación final del tratamiento adyuvante. Material y método: Estudio multicéntrico observacional de cohorte llevado a cabo en distintas Unidades de Mastología de la República Argentina que utilizaran el Oncotype Dx* para esclarecer la indicación del tratamiento adyuvante en pacientes luminales Her2neu negativas en estadio inicial. Se registraron las decisiones relacionadas con el tratamiento antes y luego de realizar la prueba genómica. El objetivo secundario consistió en describir los eventos en aquellas pacientes en quiénes se solicitó dicho estudio. Resultados: Entre enero de 2013 y diciembre de 2018, 211 pacientes con carcinomas luminales A o B, Her2neu negativas realizaron el Oncotype Dx* y fueron incluidas en el estudio. Según nuestros registros, 40% de las pacientes experimentó un cambio en la indicación del tratamiento adyuvante luego de realizada la plataforma genómica. De aquellas pacientes que tenían indicación inicial de hormonoterapia según parámetros tradicionales clínico-patológicos, 24% recibió adicionalmente quimioterapia. En relación con las pacientes que tenían indicación inicial de quimio y hormonoterapia, 49% experimentó un cambio en la indicación de su adyuvancia pudiendo realizar únicamente hormonoterapia. En relación a los eventos descriptos en las pacientes participantes del trabajo, se registraron 4 muertes específicas por la enfermedad, una muerte por otra causa, 2 recaídas a distancia y un cáncer de mama contralateral. Conclusiones: En nuestra población de estudio el uso del Score de Recurrencia (RS) resultó clínicamente significativo en relación al cambio de conducta en la toma de decisión para adyuvancia. En consecuencia, para este grupo de investigadores, ha demostrado ser una herramienta de significativa importancia en la decisión del tratamiento adyuvante de pacientes con cáncer de mama temprano, luminal, Her2neu negativo(AU)
Objetive: Currently, over half of all patients diagnosed with hormone-receptor positive early stage breast cancer will receive some type of adjuvant chemotherapy (CHT), but only a few of them will actually benefit in terms of survival. Genomic platforms allow a better understanding of the heterogeneity among the different types of hormone receptor positive, her2 negative breast cancer, and have proven their validity as tools for identifying those patients who will obtain a clear benefit from CHT. The aim of our study was to analyze the use of the genomic platform Oncotype Dx® in our population and describe its impact on the decision of adjuvant treatment assessed through change in treatment decision. Material and method: this was a real world collaborative observational study, which was performed across several Breast Units in Argentina. Patients who underwent Oncotype Dx® testing to determine adjuvant treatment were included. Decisions regarding treatment were settled before and after the oncotype was performed by the tumor boards of each Breast Unit. Results: From January 2013 to December 2018, 211 patients with luminal A or B, her 2 negative breast cancer who underwent Oncotype Dx" testing were included. We found that treatment decisions were modified after Oncotype DX in approximately 40% of patients. In 24% percent of cases, chemotherapy was added to the initial treatment plan although endocrine therapy alone had initially been considered (potential subtreatment); and on the other hand, 49% of all patients were able to receive endocrine therapy only when, due to traditional prognostic factors, they would have received chemotherapy (potential overtreatment). Conclusions: In our population, we found that the use of the Recurrence Score was associated with a significant change in treatment recommendation We therefore consider it to be a very important tool and a decisive factor for the selection of adjuvant treatment in patients with hormone receptor positive, her2neu negative early breast cancer(AU)
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Background: Ursodeoxycholic acid (UDCA), a bile acid, protects the liver through various mechanisms, including bile composition modulation and enhanced secretion. In ALL chemotherapy, 6MP is hepatotoxic, requiring dose reduction. UDCA is used to alleviate liver toxicity in ALL and other chronic cholestatic conditions. The study aims to evaluate the effectiveness of UDCA with chemotherapy in reducing 6MP treatment interruptions and its impact on treatment continuity in pediatric ALL.Methods: This randomized controlled trial study conducted at the Department of Pediatric Hematology and Oncology, BSMMU in pediatric ALL patients during chemotherapy from September 2018 to August 2019. Fifty children aged 1 to 18 years with ALL were enrolled, half receiving UDCA alongside chemotherapy and the rest forming the control group. Serum hepatic transaminases, total bilirubin, and CBC were monitored every 14 days. Statistical analysis was performed using SPSS, with significance set at p<0.05.Results: In this study of 50 pediatric ALL patients, there were no statistically significant age or gender differences between the "Case" (UDCA-treated) and "Control" groups. However, the UDCA group showed a significant decrease in abnormal liver function tests (32.0%) compared to controls (60.0%). Moreover, 6MP dose reduction was significantly lower in cases (4.0%) than controls (40.0%), indicating UDCA's potential hepatoprotective effects. Multivariate logistic regression revealed male gender and mean AST levels as significant factors associated with hepatotoxicity in pediatric ALL patients.Conclusions: Co-administration of UDCA with chemotherapy demonstrates a significant effect in treatment interruption by hepatotoxic drug specially 6 MP in pediatric ALL patients.
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Resumen Introducción. La leucemia linfoide aguda (LLA) es la neoplasia infantil más frecuente. Existen diversos protocolos de tratamiento, por lo que resulta importarte conocer su impacto en la supervivencia. Materiales y métodos. Estudio comparativo, cohorte retrospectiva. Se incluyeron pacientes menores de 16 años con diagnóstico de LLA tratados con protocolo ALL IC-BFM 2009 o esquema LLA 2008 durante enero 2020 a noviembre 2023. Se revisaron historias clínicas de los pacientes. Como instrumento se tuvo una ficha de recolección de datos. Se empleó el análisis de supervivencia de Kaplan Meier para determinar la sobrevida global (SG) y supervivencia libre de enfermedad (SLE). Resultados. Se incluyeron 107 pacientes. El grupo etario de 2-9 años fue el más prevalente en ambos grupos (57.1% y 63.3%). La SG a 32.2 meses fue 73.6% con el protocolo ALL IC BFM 09 y 43.5% con el esquema LLA 2008 (p=0.03). La SLE a 30.8 meses fue 82.3% y 51.8% respectivamente (p=0.04). Discusión. En nuestro estudio, la SG y SLE fue mayor al 70% para el protocolo ALL IC BFM 09, siendo estos hallazgos similares a lo reportado por literatura internacional. La supervivencia con el protocolo ALL IC BFM 2009 fue superior al esquema LLA 2008.
Abstract Introduction. Acute lymphoid leukemia is the most common childhood neoplasm. There are various treatment protocols, so it is important to know their impact on survival. Material and methods. Comparative study, retrospective cohort. Patients under 16 years of age with a diagnosis of ALL treated with the ALL IC-BFM 2009 protocol or the LLA 2008 scheme were included during January 2020 to November 2023. The patients' medical records were reviewed, and a data collection sheet was used as an instrument. Kaplan Meier survival analysis was used to determine overall survival (OS) and disease-free survival (DFS). Results. 107 patients were included. The age group of 2-9 years was the most prevalent in both groups (57.1% and 63.3%). OS at 32.2 months was 73.6% with the ALL IC BFM 2009 protocol and 43.5% with the LLA 2008 scheme (p=0.03). The DFS at 30.8 months was 82.3% and 51.8% respectively (p=0.04). Discussion. In our study, OS and DFS were greater than 70% for the ALL IC BFM 2009 protocol, these findings being similar to those reported in international literature. Survival with the ALL IC BFM 2009 protocol was superior to the previous institutional protocol.
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Background: Bevacizumab together with 5-fluorouracil and oxaliplatin inhibit microvascular growth of tumor blood vessels and tumor proliferation. Few reports state the effect of these therapeutic schemes on salivary glands. Materials and Methods: Food consumption, body weight and salivary amylase activity were assessed in the submandibular gland of rats. Adult male Wistar rats, of three months old with 350/400 grams body weight, under 12-hour light/dark cycles respectively, were divided into the following experimental groups: G1) Control group, G2) 5-Fluorouracil and leucovorin calcium treated group, G3) Bevacizumab treated group, G4) Oxaliplatin treated group, G5) Bevacizumab, oxaliplatin, 5-fluorouracil and leucovorin calcium treated group and G6) Drug-free paired feeding treated group. Assessment of treatment effect was performed by one-way ANOVA. A value of p<0.05 was set for statistical significance. Results: Salivary amylase activity in gland homogenate was G1: 137.9 ± 4.64, G2: 60.95±4.64, G3: 120.93 ± 4.96, G4: 26.17 ±4.64, G5: 10.77 ±4.64 and G6: 82.87 ±4.64 U/mg protein (mean ± S.D.) Amylase activity in the G1 group was higher relative to the other experimental groups p<0.0001. Conclusions: The drugs 5-fluorouracil and oxaliplatin altered salivary amylase activity by serous granules of the submandibular gland interpreted as a mechanism of impaired acinar function. Bevacizumab administered in isolation did not alter salivary amylase activity compared to the control group. While the lower intake of the matched feeding group affected salivary amylase activity compared to the control group, the effect was significantly greater in animals treated with the oncology drugs used in the present animal model.
Antecedentes: Bevacizumab, junto con 5-fluorouracilo y oxaliplatino, inhiben el crecimiento microvascular de los vasos sanguíneos tumorales y la proliferación tumoral. Pocos reportes establecen el efecto de estos esquemas terapéuticos sobre las glándulas salivales. Materiales y Métodos: Se evaluaron el consumo de alimentos, el peso corporal y la actividad de amilasa salival en la glándula submandibular de ratas Wistar macho adultas, de tres meses de edad con 350/400 gramos de peso corporal, bajo ciclos de luz/oscuridad de 12 horas respectivamente, se dividieron en los siguientes grupos experimentales: G1) Grupo control, G2) Grupo tratado con 5-Fluorouracilo y Leucovorina cálcica. , G3) Grupo tratado con bevacizumab, G4) Grupo tratado con oxaliplatino, G5) Grupo tratado con bevacizumab, oxaliplatino, 5-fluorouracilo y leucovorina cálcica y G6) Grupo tratado con alimentación emparejada sin fármacos. La evaluación del efecto del tratamiento se realizó mediante ANOVA unidireccional. Se estableció un valor de p<0,05 para significación estadística. Resultado: La actividad de amilasa salival en homogeneizado de glándula fue G1: 137,9 ± 4,64, G2: 60,95 ± 4,64, G3: 120,93 ± 4,96, G4: 26,17 ± 4,64, G5: 10,77 ± 4,64 y G6: 82,87 ± 4,64 U/mg de proteína (media ± S.E.). La actividad de amilasa en el grupo G1 fue mayor en relación con los otros grupos experimentales p<0,0001. Conclusión: Los fármacos 5-fluorouracilo y oxaliplatino alteraron la actividad de la amilasa salival mediante gránulos serosos de la glándula submandibular interpretados como un mecanismo de deterioro de la función acinar. Bevacizumab administrado de forma aislada no alteró la actividad de la amilasa salival en comparación con el grupo de control. Mientras que la menor ingesta del grupo de alimentación combinada afectó la actividad de la amilasa salival en comparación con el grupo de control, el efecto fue significativamente mayor en los animales tratados con los medicamentos oncológicos utilizados en el grupo. modelo animal actual.
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Animals , Rats , Submandibular Gland/drug effects , Cytostatic Agents/administration & dosage , Bevacizumab/administration & dosage , Fluorouracil/administration & dosage , Oxaliplatin/administration & dosageABSTRACT
Healthcare workers are better placed to recognize the drivers of the cancer health care experience by patients, an important ingredient in shaping the realization of the third pillar of the Kenya National Cancer Control Strategy. To adequately assess health systems and identify bottlenecks in cancer care, a triumvirate of factors including patient, health system, and health workforce need to be considered. For context, Kenya’s health ministry reports that 70-80% of cancer patients in Kenya are diagnosed at an advanced stage of the disease, a pointer to a gap in the detection and linkage of cancer patients to care. With increasing cancer incidence, cancer treatment centres will experience increased patient loads and will be overwhelmed in addressing individualized patient needs. Health workers can offer information on what the cancer care situation is currently like, and lessons drawn from their experience used to create adequate health systems. An adequate health system has been fashioned as one that not only address patients' needs but also generates adequate information needed to inform the transformation of those systems in line with the goals contemplated in quality healthcare. The aim of this study was to explore (i) the perspectives of health workers on the characteristics of cancer patients seen in treatment facilities and (ii) the capacity of cancer treatment facilities in the management of cancer. A key informant approach using semi-structured interviews was carried out with sampled respondents consisting of health workers (n=12) in selected facilities who were providing outpatient chemotherapy treatment. Data analysis involved transcribing the interviews into first-person narratives and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. Data analysis generated three main themes: characteristics of patients receiving chemotherapy treatment, capacity of the facility to manage cancer patients, and factors that hinder effective cancer care provision. Cancer care in Kenya is impeded by poverty, staff shortages, and lack of adequate cancer care. There is a need to reorient cancer care with an emphasis on integrated cancer care delivery modalities.
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Yolk sac tumor is a rare germ cell tumor in children, accounting for only about 3.5% of pediatric cancers. However, the yolk sac tumor is a malignant tumor that requires chemotherapy, but the side effects of chemotherapy can have an impact on the biopsychosocial and spiritual aspects of the child. This case report presents the negative impacts on the biopsychosocial and spiritual aspects of a child diagnosed with a yolk sac tumor. 11-year-old girl experienced symptoms of an enlarged abdomen, feeling bloated, pain, and frequent urination. The pathological examination revealed a yolk sac tumor, and the examination of ascites showed malignant cells. The patient was diagnosed with a yolk sac tumor, Stage 1C3, and was to undergo chemotherapy. She scored 15, indicating that the patient experienced anxiety due to the yolk sac tumor diagnosis and was anxious about the side effects of chemotherapy. Examination of the biological, psychological, social, and spiritual aspects in pediatric patients with a yolk sac tumor can assist in addressing the adverse effects of the diagnosis and the anxiety about chemotherapy in a more comprehensive manner.
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ABSTRACT Purpose: The purpose of the following study was to describe the sociodemographic, clinical, and therapeutic characteristics of patients with retinoblastoma (RB), the most common intraocular tumor in children, receiving medical care in an eyecare institution in the Caribbean region of Colombia. Methods: A case series between 2016 and 2021 was carried out. Eyes of patients with RB, receiving medical care in a single health care institution, and in compliance with the established follow-up protocol, were included. Descriptive analyzes of relevant variables were performed. Results: In this study, a total of 21 eyes of 16 patients were examined. The average age at the time of diagnosis was 17.7 months, and 50% of children were male. Using the International Classification for Intraocular Retinoblastoma, 42.9% of the total cases were classified as group D. Out of the 21 cases, 71.4% went into total remission without the necessity for enucleation, and the most common treatment was chemotherapy, using Melphalan® via intraarterial or intravitreal administration. Conclusion: Specific findings of patients with RB in the Caribbean Coast of Colombia were identified. These findings imply that, despite the obstacles to healthcare access, an early diagnosis and a treatment plan using intraarterial chemotherapy may provide a satisfactory clinical outcome (remission).
RESUMEN. Objetivo: El propósito del siguiente estudio fue describir las características sociodemográ-ficas, clínicas y terapéuticas de los pacientes con retinoblastoma (RB), el tumor intraocular más frecuente en niños, que reciben atención médica en una institución oftalmológica de la región Caribe de Colombia. Métodos: Se realizó una serie de casos entre 2016 y 2021. Se incluyeron ojos de pacientes con RB, que recibían atención médica en una sola institución de salud y cumplían con el protocolo de seguimiento establecido. Se realizaron análisis descriptivos de variables relevantes. Resultados: En este estudio se examinaron un total de 21 ojos de 16 pacientes. La edad media en el momento del diagnóstico fue de 17,7 meses y el 50% de los niños eran varones. Utilizando la Clasificación Internacional para el retinoblastoma intraocular, el 42,9% del total de los casos se clasificaron en el grupo D. De los 21 casos, el 71,4% entraron en remisión total sin necesidad de enucleación, y el tratamiento más habitual fue la quimioterapia con Melfalán® vía intraarterial o intravítrea. Conclusiones: Se identificaron hallazgos específicos de pacientes con RB en la costa caribe de Colombia. Estos hallazgos implican que, a pesar de los obstáculos en el acceso a la salud, un diagnóstico temprano y un plan de tratamiento con quimioterapia intraarterial pueden proporcionar un resultado clínico satisfactorio (remisión).
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Introduction: chemotherapy can contribute to the impairment of nutritional status and increased fatigue. Objective: the aim of this study is evaluate the influence of chemotherapy on nutritional status and oncological fatigue. Methods: this is a study with patients undergoing chemotherapy. Data collection was performed in the first chemotherapy session, in the middle and in the last session. Results: the final sample comprised 20 patients. There was an increase in the level of fatigue (p<0.05), and a difference between the percentage of weight loss (p<0.05). A direct relationship was found between fatigue and nutritional status (R= 0.484; p= 0.031). Conclusion: fatigue increase during chemotherapy and nutritional status worsens throughout the sessions, with a direct relationship between fatigue and nutritional status.
Introdução: a quimioterapia pode contribuir para o comprometimento do estado nutricional e aumento da fadiga. Objetivo: o objetivo deste estudo é avaliar a influência da quimioterapia no estado nutricional e na fadiga oncológica. Métodos: trata-se de um estudo com pacientes em tratamento quimioterápico. A coleta de dados foi realizada na primeira sessão de quimioterapia, no meio e na última sessão. Resultados: a amostra final foi composta por 20 pacientes. Houve aumento no nível de fadiga (p<0,05) e diferença no percentual de perda de peso (p<0,05). Foi encontrada relação direta entre fadiga e estado nutricional (R= 0,484; p= 0,031). Conclusão: houve aumento da fadiga durante a quimioterapia e piora do estado nutricional ao longo das sessões, havendo relação direta entre fadiga e estado nutricional.
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RESUMEN Antecedentes: el cáncer gástrico (CG) representa un problema de salud pública en Colombia y el mundo. Dado que la mayoría de los pacientes se encuentran en estadios avanzados en el momento del diagnóstico. desarrollar estrategias de manejo. como la terapia de conversión (TC). es una necesidad cada vez mayor en su tratamiento. Objetivo: estimar los resultados con la TC en el tratamiento de pacientes con CG avanzado en el Instituto Nacional de Cancerología de Colombia (INC). Material y métodos: serie de casos de pacientes con adenocarcinoma gástrico incurable llevados a quimioterapia de inducción y cirugía con intención curativa. entre los años 2010 y 2021. Se revisaron de forma retrospectiva los datos clínico-patológicos y de supervivencia. La supervivencia global (SG) se calculó desde la fecha de la primera quimioterapia hasta la muerte. Las funciones de supervivencia se estimaron con tablas de vida y por el método de Kaplan-Meier y se realizaron curvas de supervivencia a 3 y 5 años. Resultados: se analizaron los datos de 23 pacientes con edad promedio de 56 años. 17 (74%) fueron varones. El criterio de irresecabilidad más frecuente fue un tumor T4b en 13 casos (56.5%). Todos recibieron TC. La mediana de seguimiento fue de 28 meses. Se documentaron 11 recurrencias (52%). La mediana de supervivencia fue de 41.2 meses y la SG a 3 y 5 años de 57.7% y 38.5%. respectivamente. Conclusiones: la TC permitió obtener una SG aceptable de pacientes seleccionados con CG avanzado incurable. Esta estrategia requiere una cuidadosa selección y manejo multidisciplinario en centros oncológicos de referencia.
ABSTRACT Background: Gastric cancer (GC) represents a public health problem in Colombia and worldwide. Since most patients are at advanced stages at the time of diagnosis. it is necessary to develop management strategies as conversion therapy (CT). Objective: The aim of this study was to estimate the results of CT for treating patients with advanced and GC at Instituto Nacional de Cancerología de Colombia (INC). Material and methods: We included patients with incurable gastric cancer who underwent induction chemotherapy and intended curative surgery between 2010 and 2021. The clinical and pathological data and survival of the patients included were retrospectively reviewed. Overall survival (OS) was calculated from the time of initiation of chemotherapy until the date of death. Survival functions were estimated using the life table and Kaplan-Meier methods. and survival curves at 3 and 5 years were constructed. Results: 23 patients were analyzed; mean age was 56 years. and 17 (74%) were men. The most common criterion indicating unresectability was a T4b tumor in 13 cases (56.5%). All the patients underwent CT. Median follow-up was 28 months. Eleven patients developed disease recurrence (52%). Median survival was 41.2 months. and 3- and 5-year OS was 57.7% and 38.5%. respectively. Conclusions: CT provided an acceptable OS rate for selected patients with incurable advanced GC. This strategy requires an adequate selection of patients and multidisciplinary management in reference oncology centers.
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ABSTRACT Introduction and objective: The approach to patients with advanced or metastatic high-grade epithelial ovarian cancer (EOC) has evolved over time with the advent of new therapies and multimodal strategies. The objective of this consensus of experts is to generate national recommendations for the profiling and management of advanced or metastatic high-grade OEC, defined as stages III and IV of the "The International Federation of Gynecology and Obstetrics (FIGO) classification at the time of diagnosis to base on the literature review that included international evidence-based clinical practice guidelines (CPG). Material and methods: Eleven panelists (oncologists and gynecological oncologists) answered 8 questions about the profiling and management of advanced or metastatic ovarian epithelial carcinoma. The panelists were chosen for their academic profile and influence in national health institutions. Guidelines from the "ESMO Standardized Operating Procedures Consensus Conference" were used to develop the consensus. It was agreed that the level of agreement to accept a recommendation should be ≥ 80%. The document was peer reviewed. Results: Eight general recommendations are made, which are presented into five domains. Some of these recommendations are subdivided into specific recommendations. Initial treatment Recommendation 1.1 Complete primary cytoreduction (PCS) surgery is suggested as the initial therapy of choice for patients with high-grade or metastatic EOC, which should ideally be carried out in centers with experience, followed by adjuvant therapy. 1.2 Neoadjuvant chemotherapy followed by interval cytoreduction surgery (ICS) is suggested in those who are unlikely to achieve a complete cytoreduction in PCS either due to unresectable metastatic disease or who present unresectability criteria (imaging, laparoscopic and/or by laparotomy) and that have been defined by a gynecological oncologist and patients with poor functional status and comorbidities according to the criteria of the multidisciplinary team (clinical oncology, gynecological oncology, radiology, etc.). Recommendation 2. In patients with high-grade epithelial ovarian cancer (EOC), in stage III locally advanced or metastatic, who received neoadjuvant chemotherapy and achieved a complete or partial response (cytoreduction with tumor residue < 2.5 mm), the use of Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) could be considered as an alternative to standard platinum-based adjuvant intravenous chemotherapy during interval cytoreductive surgery, after discussion in a multidisciplinary tumor board, at a center experienced in treating this type of patients. Use of genetic testing. Recommendation 3. It is suggested at the time of diagnosis to offer molecular genetic testing to all patients with high-grade advanced or metastatic EOC regardless of family history. Recommendation 4. It is suggested to offer genetic counseling, by qualified personnel, to all patients with high-grade advanced or metastatic EOC who are ordered genetic testing. Recommendation 5. It is suggested that all patients with advanced or metastatic high-grade EOC undergo a germ panel that includes the Breast Cancer Susceptibility Genes 1/2 genes (BRCA 1/2) and the other susceptibility genes according to with institutional protocols and the availability of genetic testing panels; If it is negative, then somatic testing should be performed that includes the homologous recombination deficiency (HRD) status, regardless of family history. Adjuvant Therapy Recommendation 6. 6.1. It is suggested that all patients with advanced stage III/IV EOC, with PSC of (0-2), got adjuvant intravenous chemotherapy as standard treatment within six weeks after Prc. It is suggested paclitaxel/carboplatin. Recommendation 6.2. It is suggested to use standard chemotherapy base on platinum plus Bevacizumab as adjuvant chemotherapy to patients with high-risk disease (EOC stage IV or stage III with suboptimal tumor cytoreduction), following by bevacizumab as maintenance. The use of bevacizumab as maintenance therapy is not recommended if bevacizumab was not included in the first line of treatment. We suggested the dose used in GOG-0218 and ICON7 trials. Recommendation 6.3 It is suggested combined intravenous/intraperitoneal chemotherapy only for selected patients, with optimal cytoreduction (residual lesions < 1 cm), especially those without residual disease (R0) and who are evaluated in a multidisciplinary meeting. It is not considered standard treatment. Recommendation 6.4. 6.4.1 It is suggested to use Poly ADP ribose polymerase (PARP) inhibitors such as olaparib or niraparib as maintenance after receiving first-line chemotherapy in patients with stage III/ IV BRCA1/2 positive EOC who received platinum-based chemotherapy and obtained complete response/ partial response (CR/PR), 6.4.2 It is suggested to use olaparib alone or in combination with bevacizumab or niraparib in patients with stage III/IV BRCA1/2 positive EOC who received platinum-based chemotherapy plus bevacizumab and achieved CR/PR. 6.4.3 It is suggested to use niraparibin patients with stage III/IV BRCA1/2 negative or unknown EOC who received platinum-based chemotherapy and achieved CR/PR, 6.4.4 It is suggested to use bevacizumab or olaparib plus bevacizumab in patients with EOC stage III/ IV BRCA1/2 negative or unknown (HRD positive) who received platinum-based chemotherapy plus bevacizumab and obtained CR/PR. Treatment of disease relapse Recommendation 7. Secondary cytoreductive surgery followed by chemotherapy is suggested for selected patients with high-grade advanced EOC in first relapse, platinum-sensitive (platinum-free interval ≥ 6 months), positive "Arbeitsgemeinschaft Gynäkologische Onkologie - AGO" score or "I-model" positive (< 4.7) with a potential resection to R0 in centers with access to optimal surgical and postoperative support. Note: Platinum-free interval and AGO score have only been developed as positive predictors of complete resection and not to exclude patients from surgery. Recommendation 8. 8.1 For patients with relapse advanced high-grade EOC platinum-sensitive, the following is suggested: • Platinum-based combination chemotherapy: carboplatin/liposomal doxorubicin or carboplatin/ paclitaxel or carboplatin/nab-paclitaxel or carboplatin/docetaxel or carboplatin/gemcitabine) for six cycles. If combination therapy is not tolerated, give carboplatin or cisplatin alone. • Combination chemotherapy (carboplatin/ gemcitabine or carboplatin/paclitaxel or carboplatin/doxorubicin liposomal) plus bevacizumab followed by bevacizumab as maintenance (until progression or toxicity). Recommendation 8.2 For patients with relapsed advanced high-grade EOC platinum-resistant, it is suggested: • Sequential treatment with chemotherapy, preferably with a non-platinum single agent (weekly paclitaxel or pegylated liposomal doxorubicin or docetaxel or oral etoposide or gemcitabine or trabectidine or, topotecan). Weekly paclitaxel or pegylated liposomal doxorubicin or topotecan could be administrate with or without bevacizumab. • Other agents are considered potentially active (capecitabine, cyclophosphamide, ifosfamide, irinotecan, oxaliplatin, pemetrexed, vinorelbine, cyclophosphamide) could be recommended for later lines. • Hormone receptor-positive patients who do not tolerate or have no response to cytotoxic regimens may receive hormone therapy with tamoxifen or other agents, including aromatase inhibitors (anastrozole and letrozole) or leuprolide acetate, or megestrol acetate. • Patients with a performance score ≥ 3 should be considered only for best supportive care. Recommendation 8.3 Maintenance therapy with PARP inhibitors: It is suggested in patients with relapse advanced high-grade EOC stage III/IV BRCA1/2 (positive, negative or unknown) who have received two or more lines of platinum-based chemotherapy and have achieved CR/PR, use olaparib, niraparib or rucaparib. Niraparib could be useful in BRCA ½ +/-/unknown patients, as rucaparib, however, the latter does not yet have approval from the regulatory office in Colombia. Conclusions: It is expected that the recommendations issued in this consensus will contribute to improving clinical care, oncological impact, and quality of life of these women.
ABSTRACT
Head and neck cancer (HNC), in current days, is one of the fatal diseases. Chemotherapy is one of the main treatments for cancer. Chemotherapy has an adverse impact on the respiratory parameters of patients. In these patients, expiratory force-generating capacity is impaired, which usually helps the patients cough effectively for airway clearance. Thus, as an impact of chemotherapy, airway clearance is affected in HNC patients. This study aimed to evaluate the impact of chemotherapy expiratory muscle strength in stage 1 head and neck cancer patients. We conducted an observational study including 15 patients with stage 1 HNC in the department of oncology in a tertiary care teaching hospital. The outcome measure included assessment of the expiratory muscle strength by measuring maximum expiratory pressure. In our study, we found a result showing a significant decline of 53.43% in maximum expiratory pressure values after 3-6 months of required chemotherapy sessions. The results of the current study suggest that chemotherapy has a deleterious impact on the expiratory muscle strength in stage 1 HNC patients after long-term exposure.
ABSTRACT
Mucinous ovarian cancer (MOC) represents a rare subtype within the spectrum of epithelial ovarian carcinoma (EOC). In contrast to a uniform approach applied to all EOC subtypes, MOC stands out as a distinctive entity. A nuanced understanding of the pathological features and genomic profile of MOC holds the potential for enhancing management strategies and, consequently, prognostic outcomes. The differentiation between primary MOC and metastatic mucinous carcinoma poses a challenge but is imperative for accurate clinical decision-making. Notably, early-stage MOC exhibits a favourable prognosis, while advanced disease is characterized by a less favourable outcome. Surgical intervention assumes a pivotal role both in the early stages and metastatic scenarios. Chemotherapy is typically initiated from stage II MOC onwards, with the conventional gynaecological protocol commonly employed; however, there is also precedent for the application of gastrointestinal (GI) regimens. Given the association of MOC with diverse molecular alterations, the consideration of targeted therapy emerges as a potential therapeutic avenue for this unique disease entity. The main tool used for this literature review was PubMed. MOC stands as a distinct entity within EOC subtypes, distinguished from GI mucinous carcinoma by its unique clinical behavior, pathological features, molecular profile, prognosis, and response to standard treatment. The challenges lie in both the diagnosis and treatment of MOC, emphasizing the complexity and specialized considerations required for managing this particular subtype of OC.
ABSTRACT
Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition impairs immune function, leading to increased incidence of infection, poor quality of life, as well as death. Febrile neutropenia (FN) has a high prevalence in children with acute lymphoblastic leukemia (ALL) and a poor outcome as well.Methods: This prospective observational study was done in the department of pediatrics hematology and oncology (PHO), BSMMU, from January 2021 to October 2021. A total of 60 patients of ALL were selected purposively. Patients were evaluated by taking anthropometric parameters before getting chemotherapy and were prospectively followed up for the development and outcome of FN until recovery. Statistical analysis was performed by using SPSS (Statistical package for the social sciences) for Windows version 26.0.Result: Analysis of nutritional status as a risk factor for FN based on anthropometric indices, was found statistically significant for, weight for height (?5 years) p=0.036, OR=0.24 (95% CI= 0.06-0.958), weight for age p=0.006, OR=0.23 (95% CI=0.07-0.67), but for BMI for age (>5 years) p=0.28, OD=0.28 (95% CI=0.02-3.19), and height for age p=0.513, OD=0.66 (95% CI=0.18-2.33) no statistically significant value was found. In this study, we found mortality rate was 15%. The mortality rate was significantly worse (27.3%) for patients who were malnourished at diagnosis as compared to those who were well nourished (7.9%) at diagnosis.Conclusions: FN and its complications are more common in malnourished children with ALL. Malnutrition is associated with adverse outcomes of FN in children with ALL.
ABSTRACT
Background: Chemotherapy-induced nausea and vomiting (CINV), represents a common and distressing side effect associated with antineoplastic treatment in pediatric patients. Aprepitant, a selective neurokinin-1 receptor antagonist, is recommended for preventing CINV in combination with a standard antiemetic regimen in children undergoing chemotherapy. This study aimed to evaluate the effectiveness of aprepitant as an add-on therapy to the standard antiemetic regimen for the prevention of CINV in children.Methods: This randomized control study was conducted in the BSMMU, Dhaka, Bangladesh from February 2020 to October 2020. Forty-six children with malignancy undergoing chemotherapy were divided into two arms: the Aprepitant arm (23 patients receiving granisetron, dexamethasone, and aprepitant) and the control arm (23 patients receiving Granisetron and Dexamethasone). Data were analyzed using SPSS version 22.0.Results: The complete response rates for the aprepitant versus control arm during the acute and overall phase were 82% vs. 40% (p=0.003) and 65% vs. 26% (p=0.008), respectively. However, a higher percentage of patients who achieved complete response in the delayed phase was also observed, though statistically not significant (65% vs 40%, p=0.077). In the acute phase, there was a significant reduction in mild to moderate vomiting in the Aprepitant arm as compared to the control arm (p=0.01). In the overall phase, 35% of patients in the Aprepitant arm had mild to moderate vomiting as compared to 74% in the control group (p=0.027). No major adverse effects were reported by patients or caregivers.Conclusions: Adding Aprepitant to the standard antiemetic regimen was effective and safe in preventing CINV, especially in the acute phase, in pediatric patients receiving the moderately and highly emetogenic chemotherapy (HEC).
ABSTRACT
Objective To explore the clinical efficacy and safety of probiotic-assisted chemotherapy in patients advanced colorectal cancer(CRC).Methods Patients with advanced CRC admitted to the First Affiliated Hospital of Hunan Normal University from March 2022 to March 2023 were enrolled.CRC patients were randomly divided into the test group(Bifidobacterium triple viable capsule,capecitabine+oxaliplatin)and the control group(capecitabine+oxaliplatin)by random number table method.The short-term efficacy(objective response rate and disease control rate),incidence of gastrointestinal adverse reactions,Karnofsky performance status(KPS)score,and serum tumor markers CA72-4,CA19-9 and CEA levels were compared between the two groups.Results A total of 120 patients with CRC were included,including 60 patients in the test group and 60 in the control group.Compared with the control group,the objective remission rate and disease control rate in the testl group were significantly higher(P<0.05).There was no significant difference in the incidence of nausea and acid reflux between the two groups(P>0.05),and the incidences of abdominal pain,bloating,constipation and diarrhea in the test group were significantly lower than those in the control group(P<0.05).There was no significant difference in KPS score,serum CA72-4,serum CA19-9 and serum CEA levels between the two groups before treatment(P>0.05),and after 4 weeks of treatment,the KPS score of the test group was significantly higher than that of the control group(P<0.05),and the serum levels of CA72-4,serum CA19-9 and serum CEA were lower than those of the control group(P<0.05).Conclusion Probiotics-assisted chemotherapy improve the near-term efficacy,reduce gastrointestinal adverse effects,and improve the quality of life in patients with advanced CRC.
ABSTRACT
Neoadjuvant chemoradiotherapy is a part of the current standard treatment mode for locally advanced rectal cancer,which enables a certain proportion of patients to achieve complete tumor response,improving the surgical resection rate and anal retention rate,and then prolonging the disease-free survival period of patients.MRI is the preferred imaging examination to evaluate the efficacy of neoadjuvant therapy.With the development of functional MRI,quantitative parameters derived from different imaging principles can provide more biological information about tumors,improving the clinical application value of MRI.Multi-parameter MRI combining conventional MRI sequences and functional sequences can more comprehensively evaluate the efficacy of neoadjuvant therapy,which is conducive to developing individualized treatment plans for patients in clinical practice and realize precision medicine.