Résumé
Many patients with relapsed metastatic breast cancer are pre-treated with taxanes and anthracyclines, which are usually given in the neoadjuvant/adjuvant setting or as first-line treatment for metastatic disease. The primary objective of this study was to determine the overall response rate for combination treatment with gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer who had relapsed after receiving one adjuvant/neoadjuvant or first-line metastatic chemotherapy regimen containing an anthracycline with/without a taxane. Secondary endpoints included duration of response, time to progression, one-year survival probability, and toxicity. A single-arm, open-label, phase 2 study conducted at 1 7 investigative sites in Egypt. Treatment consisted of gemcitabine [1250 mg/m[2]] on Days 1 and 8 and cisplatin [70 mg/m[2]] on Day 1 of each 21-day cycle. Treatment continued until disease progression or a maximum of 6 cycles. Of 144 patients all were evaluable for safety and 132 patients were evaluable for efficacy. The overall response rate was 33.3% and 45.5% of the patients with stable disease as their best response. The median time to progression was 5.1 months and the one-year survival probability was 73%. The most common grade 3/4 adverse events were nausea/vomiting [20.1%], neutropenia [19.4%], anemia [13.9%], asthenia [11.1%], diarrhea [9.7%], stomatitis [7.6%], leucopenia [7.6%], and thrombocytopenia [6.2%]. Twelve [8.3%] patients had serious adverse events. The results of this study indicate that gemcitabine and cisplatin were active and generally well tolerated in pretreated patients with locally advanced or metastatic breast cancer
Résumé
Impalpable undescended testes offer a greater diagnostic and therapeutic challenge for the radiologist and the surgeon. Evaluation of the impalpable testis using diagnostic laparoscopy has received appreciable support in the last years. Laparoscopy to evaluate the impalpable testis has also a great impact on treatment. In this study 36 children with impalpable testes underwent diagnostic and therapeutic laparoscopy for evaluation of impalpable testis. 9 patients had bilateral and 27 patients had unilateral impalpable undescended testis. The left testis was affected in 16 boys and the right in 11. Laparoscopy localized 29 [64.4%] testes out of 45 impalpable testes and 16 [35.6%] blind ended vas deferens. Two-stage Fowler-Stephens orchidopexy was performed in 6 testes [4unilateral and 1 bilateral cases]. The remainder, or 23 intra-abdominal testes [79.3%], were mobilized sufficiently to allow scrotal placement without dividing the testicular vessels. The overall success rate for all Fowler-Stephens procedures was 83.3% [5 out of 6], for all single stage laparoscopic orchidopexies was 91.3% [21 out of 23] and for all laparoscopic procedures was 89.66% [26 out of 29] where 26 out of 29 testes were placed successfully in the scrotum with no atrophy. Laparoscopy for the impalpable undescended testis offers a simultaneous diagnostic and therapeutic tool. It obviates the need for invasive and/or expensive diagnostic imaging and saves the patient an extensive surgical procedure. This study recommends laparoscopic orchidopexy as the treatment of choice for the impalpable undescended testis