Résumé
BACKGROUND: The 5‑year survival rate for metastatic renal cell carcinoma (RCC) is estimated to be <10%. RCC is highly resistant to chemotherapy. Targeted agents are now first choice of therapy for metastatic RCC such as sunitinib and sorafenib. METHODS: This study is a retrospective analysis of 15 patients having metastatic RCC treated with sunitinib. Apart from three patients, all had clear cell histology. Thirteen patients received dosage of 50 mg/d (4 weeks on/2 weeks off cycles). In 14 patients sunitinib was used as 1st line. The primary end point was objective response rate. Secondary end points were progression free survival (PFS) and safety. RESULTS: Until date of reporting, 3 out of 15 patients are currently on sunitinib. The most common Memorial Sloan = Kettering Cancer Centre poor prognostic factor was an interval of <1 year between diagnosis and starting of treatment (80%). The objective response rate was 13.66% (complete response [CR] + partial response [PR] = 0 + 2). Clinical benefit rate (CR + PR + stable disease) was 60% (n = 9). Median PFS in this study was 7.5 months, with a range of 2‑22 month. Median overall survival (OS) of patients in this study was 12 months with a range of 3‑24 month. An impact of the dose or/and number of cycles on response was seen in this study, with patients having average cycles >3 showing better response rates, PFS and OS. Major toxicities seen were fatigue ( n = 7), diarrhea (n = 3) and skin rash (n = 4) with majority patients experienced Grade 1‑2 toxicities. While Grade 3‑4 toxicities include fatigue (n = 1), mucositis (n = 1) and nausea (n = 1). CONCLUSIONS: These results confirm efficacy and safety profile of sunitinib in metastatic RCC, particularly as a first line. Sunitinib produced a 60% disease control rate for metastatic RCC in Indian patients, with acceptable rates of toxicity at a dose of 50 mg daily. Response rates were well matched to other studies confirming the efficacy of sunitinib.
Résumé
Background: This study was intended to throw light upon the topic of acute pancreatitis, its incidence, etiology, pathogenesis as well as its management. Aim and objectives: To review and study the patients who presented with acute pancreatitis, to find out the incidence of acute pancreatitis and study the various etiological factors, to study the various modalities of treatment of acute pancreatitis, both conservative as well as operative, to study the incidence and management of complications of acute pancreatitis, factors influencing incidence as well as its outcome. Materials and methods: This was a prospective study of management of 50 cases of acute pancreatitis, admitted in surgical department. All admitted patients underwent work up for the diagnosis and cause of Acute Pancreatitis. The severity grading was done according to the Ranson’s criteria. All patients were monitored with serial examinations and investigations. Patients with mild pancreatitis were treated conservatively at first and surgical intervention was done only in cases of gallstone pancreatitis with diagnosed GB or CBD calculi. Surgical intervention was in form of cholecystectomy or ERCP. Patients with severe pancreatitis were treated conservatively at first. Outcome was monitored in terms of discharge from hospital or mortality. Each patient was evaluated as per the predesigned proforma of the study, a copy of which is attached. Follow up of a minimum of six months was kept and patients with recurrent attacks were monitored and treated either conservatively or surgically as indicated. Results: The highest incidence of acute pancreatitis was found in the age group of 41 to 60 years followed by the age group of 21 to 40 years. Acute pancreatitis was found more commonly in males. Desai A, Panchal H, Parmar H. Acute pancreatitis: Causes, pathophysiology, different modalities of management. IAIM, 2016; 3(4): 66-71. Page 67 (41 out of 50 that is 82%) compared to females (9 out of 50 that is 18%). Alcohol was found to be the most common cause of acute pancreatitis (44%) , followed closely by Gallstones (36%), While in 10% of patients no cause could be found (idiopathic group). Overall conservative management is favorable over surgical management in terms of mortality in about 70% of cases. Mortality was not found in the mild pancreatitis group and all 34 patients were discharged. However, 6 out of 16 patients with severe pancreatitis expired (37.5%). Conclusion: Conservative management is more favourable in both mild and severe type of acute pancreatitis.