ABSTRACT
Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient's values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine.
Subject(s)
Medical Oncology/ethics , Neoplasms/therapy , Terminal Care/ethics , Advance Care Planning , Communication , Humans , Medical Oncology/methods , Morals , Neoplasms/mortality , Neoplasms/pathology , Terminal Care/methodsABSTRACT
Cancer of unknown primary site is a histologically confirmed cancer which is manifested in advanced stage, with no identifiable primary site after the use of standard diagnostic procedures. Patients are initially placed into one of categories based upon the examination of the initial biopsy: adenocarcinoma, squamous cell carcinoma, neuroendocrine carcinoma and poorly differentiated carcinoma. Appropriate patient management requires an understanding of several clinicopathologic features that help to identify several subsets of patients with more responsive tumors.
Subject(s)
Carcinoma/diagnosis , Carcinoma/therapy , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/therapy , HumansABSTRACT
PURPOSE: This single arm, phase II study aims to evaluate the role of epidermal growth factor receptor-tyrosine-kinase inhibitor erlotinib as maintenance therapy following concurrent chemoradiotherapy (cCRT) in unresectable locally advanced non-small-cell lung cancer (NSCLC). METHODS: Patients with unresectable stage IIIA o dry IIIB NSCLC with no evidence of tumor progression after receiving a standard cCRT regimen with curative intent were included. Oral erlotinib 150 mg/day was administered within 4-6 weeks after the end of the cCRT for a maximum of 6 months if no disease progression or intolerable toxicity occurred. Primary end point was the progression-free rate (PFR) at 6 months. Secondary end points included time to progression (TTP) and overall survival (OS). RESULTS: Sixty-six patients were enrolled and received maintenance treatment with erlotinib [average: 4.5 months (95 % CI 4.0-5.0)]. PFR at 6 months was 63.5 % (41/66). With a median follow-up of 22.7 months (95 % CI 13.5-37.1), the median TTP was 9.9 months (95 % CI 6.2-12.1), and the median OS was 24.0 months (95 % CI 17.3-48.6). Most common adverse events (AEs) related to erlotinib were rash (78.8 %; 16.7 % grade 3), diarrhea (28.8 %; 1.5 % grade 3), fatigue (15.2 %; 1.5 % grade 3), anorexia (7.6 %; 1.5 % grade 3) and vomiting (4.6 %; none grade 3). Five patients (7.6 %) were withdrawn due to AEs. CONCLUSIONS: Erlotinib as maintenance therapy is an active treatment after cCRT in unselected patients with stage III NSCLC, reaching a 6-month PFR of 63.5 % and a median OS of 24 months. The safety profile of maintenance erlotinib was as expected and manageable.
Subject(s)
Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/administration & dosage , Quinazolines/administration & dosage , Adult , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Chemoradiotherapy , Disease Progression , Disease-Free Survival , Erlotinib Hydrochloride , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Prognosis , Protein Kinase Inhibitors/adverse effects , Quinazolines/adverse effects , Survival RateABSTRACT
The clinical and radiographic manifestations of pulmonary nocardiosis are nonspecific. The diagnosis depends of the clinical suspicion for alerting the microbiology laboratory to use special culture and identification methods to initiate the appropriate therapy early. A nocardia pneumonia in a locally advanced non small cell lung cancer patients is present. Even after initiate the treatment the patient died. It is important to suspect the diagnosis of uncommon infection to begin the therapy.
Subject(s)
Lung Neoplasms/complications , Nocardia Infections/complications , Pneumonia, Bacterial/complications , Aged , Fatal Outcome , Humans , Male , Nocardia/isolation & purification , Nocardia Infections/diagnosis , Pneumonia, Bacterial/diagnosisABSTRACT
El cáncer de origen desconocido es un diagnóstico frecuente en la práctica médica y representa un grupo heterogéneo de neoplasias. A pesar de que los datos de la literatura indican que excepcionalmente se identifica el tumor primario, estos pacientes son evaluados exhaustivamente. El tratamiento está orientado principalmente por el diagnóstico anatomopatológico de la lesión, siendo fundamental las técnicas anatomopatológicas especiales para la correcta identificación de aquellas neoplasias quimiocurables y aquellas que se benefician de un tratamiento específico. Los pacientes que por sus características no pertenezcan a estos grupos deberían ser incluidos dentro de ensayo clínico (AU)
Subject(s)
Female , Male , Humans , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/therapy , Neoplasms, Unknown PrimaryABSTRACT
Las manifestaciones clínicas y radiográficas de nocardiosis pulmonar son inespecíficas. El diagnóstico depende de un alto grado de sospecha, altertando al laboratorio de microbiología para obtener un aislamiento y cultivo precoz e iniciar el tratamiento antibiótico específico. Presentamos un caso de neumonía por Nocardia nova en un paciente diagnosticado de carcinoma epidermoide de pulmón localmente avanzado, iniciándose el tratamiento antibiótico específico (AU)
Subject(s)
Aged , Male , Humans , Fatal Outcome , Nocardia/isolation & purification , Pneumonia, Bacterial , Nocardia Infections , Lung Neoplasms , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/diagnosis , Nocardia Infections/complications , Nocardia Infections/diagnosis , Lung Neoplasms/complicationsABSTRACT
The carcinoma of unknown primary is a frequent clinical problem and represents a very heterogeneous group of neoplasms. Despite data in the literature indicating minimal success in determining the location of primary carcinomas, these patients continue to be evaluated exhaustively. Clinical treatment is guide by the pathological evaluation of the lesion and is very important the special pathologic techniques characterizing a potentially curable malignancy or patients for whom there is are a specific treatment. The majority of the patients are not included in these groups and they should be received treatment in clinical trials.
