Subject(s)
Humans , Combined Modality Therapy/trends , Neoplasms , Neoplasms/drug therapy , Quality of LifeABSTRACT
Multiple therapeutic modalities are available for hepatocellular carcinoma (HCC) treatment. We aimed to evaluate the trends for HCC treatment in Korea. Recent trends and patterns in treatment modalities were assessed in HCC patients who first registered for the Health Insurance Review Assessment Service between 2008 and 2012. From 2009 to 2012, 57,690 patients were diagnosed with HCC. Transcatheter arterial chemoembolization (TACE) was the most common treatment modality for initial treatment. Curative treatment modalities like hepatic resection, liver transplantation, and local ablation therapy increased gradually. The 3 most common treatment modalities (hepatic resection, local ablation therapy, TACE) used after initial treatment in 2009 were studied. Following initial hepatic resection, 44.5% of patients required re-treatment. TACE was the most common modality (in 48.3% of cases), while 15.0% of patients received local ablation therapy. After local ablation therapy, 55.4% of patients were re-treated, wherein 45.0% of patients received TACE and 31.5% received local ablation therapy. Following initial TACE, 73.9% patients were re-treated, most commonly with TACE (57.7%) followed by local ablation therapy (12.8%). While there were no significant differences between the initial and re-treatment modalities, various multiple treatments followed the initial treatment. The treatment modalities were interchangeable.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/epidemiology , Chemoembolization, Therapeutic , Combined Modality Therapy/trends , Cross-Sectional Studies , Databases, Factual , Insurance Claim Review , Liver Neoplasms/epidemiology , Liver Transplantation , Niacinamide/administration & dosage , Phenylurea Compounds/administration & dosage , Prevalence , Protein Kinase Inhibitors/administration & dosage , Republic of Korea/epidemiologyABSTRACT
Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide. This cancer commonly arises against a background of chronic liver disease. As a result, a patient with HCC requires multidisciplinary care. Treatment options vary widely based on tumor burden and metastases. The most widely utilized staging system is the Barcelona Clinic Liver Cancer staging system, which recommends treatments based on tumor size and the underlying liver disease and functional status of the patient. Treatment options range from surgical resection or transplantation to locoregional therapies with modalities such as radiofrequency ablation and transarterial chemoembolization to systemic chemotherapies. Future care involves the development of combination therapies that afford the best tumor response, further clarification of the patients best suited for therapies and the development of new oral chemotherapeutic agents.
Subject(s)
Humans , Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/pathology , Catheter Ablation/trends , Chemoembolization, Therapeutic/trends , Combined Modality Therapy/trends , Forecasting , Liver Neoplasms/pathology , Liver Transplantation , Neoplasm Staging/methodsABSTRACT
Os autores discutem a terapêutica para a artrite reumatoide (AR), com foco no tratamento biológico. Novos conhecimentos dos mecanismos patogênicos da AR mais a aplicação de biotecnologia propiciaram o desenvolvimento de tratamentos específicos contra moléculas envolvidas na inflamação da doença, os chamados tratamentos biológicos. Estes fármacos representam o maior avanço no controle da AR nesta última década. 0s agentes biológicos habitualmente aprovados para uso na AR são: etanercepte, receptor solúvel do TNE infliximabe e adalimumabe, ambos anticorpos monoclonais contra TNF. Todos estão disponíveis para uso pela secretaria de saúde. Outros aprovados para uso e não disponibilizados pela secretaria são o rituximabe e o abatacepte. Neste artigo discutimos cada um destes biológicos.
Authors discuss the therapies for rheumatoid arthritis focused on biological therapies. Biological therapies are the result of new insights into the pathogenic mechanisms of RA and the application of biotechnology on the development of therapies directed specifically against molecules involved with the inflammatory process of the disease. These agents represent the greatest advance in the control of RA during the last decade. Biological agents currently approved and accessible by government for the treatment of RA include: etanercept, a soluble recombinant anti-TNF receptor construct, in fliximab and adalimumab, both monoclonal antibodies against TNF. The others biologic, rituximab and abatacept, are also approved for treatment of RA but not available by government. In this essay authors study each one of these biologics agents.
Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/etiology , Arthritis, Rheumatoid/physiopathology , Arthritis, Rheumatoid/therapy , Anti-Inflammatory Agents, Non-Steroidal , Antirheumatic Agents , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Immunosuppressive Agents/therapeutic use , Biological Therapy/trends , Combined Modality Therapy/trendsABSTRACT
O acesso à terapia antirretroviral (TARV) tem garantido uma melhoria significativa na qualidade de vida dos indivíduos HIV--positivos, sobretudo em países onde a distribuição destes medicamentos é gratuita, como no Brasil. Entretanto, um dos principais fatores associados à falha terapêutica é o surgimento de resistência às drogas e a transmissão de vírus resistentes. O presente artigo apresenta os mecanismos de atuação das drogas antirretrovirais (ARVs) em uso, a epidemiologia da resistência do HIV-I, suas consequências, bem como novas perspectivas de tratamento.
Access to antiretroviral therapy has granted a significant improvement in quality of life for HIV-I positive individuals, especially in countries where treatment is free-of-charge, such as Brazil. However, one of the leading factors associated with treatment failure is the development and transmission of resistant viruses. This present article presents the mechanisms of action of antiretroviral drugs (ARVs) in use, the epidemiology and consequences of HIV-I resistance, and new treatment perspectlves.
Subject(s)
HIV-1 , Acquired Immunodeficiency Syndrome/therapy , Anti-HIV Agents/pharmacokinetics , Anti-HIV Agents/therapeutic use , Viral Load/immunology , Drug Resistance, Viral , HIV Protease Inhibitors , Prevalence , Virus Replication/immunology , Combined Modality Therapy/trendsABSTRACT
El cáncer esofágico es uno de los tumores de peor pronóstico debido a su bajo porcentaje de resecabilidad y baja sobrevida a 5 años plazo. Durante los últimos 20 años se han analizado tratamientos multimodales incluyendo quimioterapia y radioterapia pre y postoperatoria. El objetivo de este trabajo es analizar nuestra experiencia en el manejo de esta patología durante los últimos 20 años. Se incluye en este estudio a 51 pacientes, 27 hombres y 24 mujeres cuyas edades fluctúan entre 42 y 83 años, presentan un período sintomático promedio previo a la consulta de 13,4 meses. Disfagia se presentó en 83,3 por ciento de los casos. En 31 casos el tumor se localizó en el tercio inferior del esófago y el resto en el tercio medio; 44 casos fueron cánceres escamosos y 7 adenocarcinomas. Treinta y seis pacientes se operaron a través de taracotomía derecha y en 15 se hizo una resección transhiatal, 3 casos resultaron irresecables. En todos los pacientes se usó un tubo gástrico y yeyunostomía de alimentación por 26 días en promedio. Radioterapia pre y postoperatoria se hizo en 40 casos. La sobrevida promedio fue de 40 meses y 7 casos vivieron más de 10 años. Esta sobrevida es similar a publicaciones nacionales e internacionales y concluimos que ésta podría atribuirse a la asociación de cirugía y radioterapia.
Subject(s)
Humans , Male , Female , Chemotherapy, Adjuvant , Chest Tubes , Esophageal Neoplasms , Postoperative Complications , Survival Rate , Jejunostomy , Combined Modality Therapy/trendsABSTRACT
Se presentan 40 pacientes operados por metástasis pulmonares. Correspondieron a 31 carcinomas y 9 sarcomas, siendo los origenes más frecuentes el carcinoma de colon, de mama y osteosarcoma con 6 casos cada uno. La edad promedio fue de 53 años para los carcinomas y de 26 años para los sarcomas. Treinta y seis casos (80%) fueron asintomáticos, 32 diagnosticados por control radiológico periódico y 4 por TAC periódica. La TAC de toráx se constituyó en el estudio más útil para la evaluación de las lesiones torácicas. En los 40 pacientes se realizaron 45 resecciones, 1 caso se operó 3 veces y 3 casos, 2 veces. La resección de metástasis pulmonares con criterio oncológico es viable en un grupo seleccionado de pacientes, siendo las resecciones pulmonares menores (segmento y cuña) los procedimientos de preferencia. Las metástasis múltiples y/o bilaterales no son una contraindicación quirúrgica. El índice de sobrevida actuarial a 5 años fue mayor para los sarcomas (67%) que para los carcinomas (30%); el índice global fue de 41%. Ocho de los 9 sarcomas recibieron quimioterapía adyuvante. La sobrevida a 5 años en los pacientes con un intervalo libre tumoral de más de 36 meses fue del 59%contra 28%de aquellos con un intervalo libre menor de 36 meses. La mortalidad operatoria fue del 2,2