ABSTRACT
BACKGROUND: Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties. OBJECTIVES: To assess the effectiveness and safety of radiotherapy on patients with malignant pleural mesothelioma in any stage of the disease. SEARCH STRATEGY: Both electronic and handsearches were conducted. All randomised controlled clinical trials were searched in electronic databases such as: Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Handsearching was aimed at the identification of evidence by reviewing journals not indexed in databases, proceedings of conferences and/or scientific meetings. SELECTION CRITERIA: All randomised controlled clinical trials using radiotherapy for malignant pleural mesothelioma in any stage, alone or combined with other therapies in patients of either sex and any age, were included. Studies without a control group were excluded. DATA COLLECTION AND ANALYSIS: There were no studies that fulfilled the inclusion criteria. MAIN RESULTS: To date we have not found any reports of randomised comparisons of radiotherapy alone or combined for patients with malignant pleural mesothelioma. AUTHORS' CONCLUSIONS: As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, no data exist supporting one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.
Subject(s)
Mesothelioma/radiotherapy , Pleural Neoplasms/radiotherapy , HumansABSTRACT
BACKGROUND: Megestrol acetate (MA) is currently used to improve appetite and to increase weight in cancer-associated anorexia. In 1993 MA was approved by the USA's Federal Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with AIDS. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic and AIDS patients is under investigation. OBJECTIVES: To evaluate the efficacy, effectiveness and safety of MA in palliating anorexia-cachexia syndrome in patients with cancer, AIDS and other underlying pathologies. SEARCH STRATEGY: Studies were sought thorough an extensive search of the electronic databases, journals, reference lists, contact with investigators and other search strategies outlined in the methods. The most recent search was carried out on October 2002. SELECTION CRITERIA: Studies were included in the review if they assessed megestrol acetate compared to placebo or other drug treatments in randomized controlled trials of patients with a clinical diagnosis of anorexia-cachexia related to cancer, AIDS or another underlying pathology. DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two independent authors, and methodological quality evaluated. Quantitative analyses were performed using appetite and quality of life as a dichotomous variable, and weight gain was analysed as continuous and dichotomous variables. Studies with more than 50% of patients lost to follow-up were excluded from the analysis. MAIN RESULTS: Thirty trials met the inclusion criteria (4123 patients). Twenty-one trials compared MA at different doses with placebo; four compared different doses of MA versus other drugs; two compared MA with other drugs and placebo; and three compared different doses of MA. For all patient conditions, meta-analysis showed a benefit of MA compared with placebo, particularly with regard to appetite improvement and weight gain in cancer patients. Analysing quality of life, clinical and statistical heterogeneity was found and discussed. There was insufficient information to define the optimal dose of MA. AUTHORS' CONCLUSIONS: This review demonstrates that MA improves appetite and weight gain in patients with cancer. No overall conclusion about quality of life (QOL) could be drawn due to heterogeneity. The small number of patients, methodological shortcomings and poor reporting have not allowed us to recommend megestrol acetate in AIDS patients or with other underlying pathologies.
Subject(s)
Anorexia/drug therapy , Appetite Stimulants/therapeutic use , Cachexia/drug therapy , Megestrol Acetate/therapeutic use , Acquired Immunodeficiency Syndrome/complications , Anorexia/etiology , Cachexia/etiology , Humans , Neoplasms/complications , Randomized Controlled Trials as Topic , SyndromeABSTRACT
La Gastrostomía Endoscópica Percutánea (PEG) es un método rápido y seguro de acceso a la alimentación enteral en pacientes de alto riesgo para ser sometidos a una gastrostomía abierta y que requieran de nutrición enteral prolongada con el fin de lograr un adecuado soporte nutricional. El objetivo de este estudio fue evaluar la tolerancia en el uso de la PEG, medir las complicaciones inmediatas y tardías y evaluar el estado nutricional de los pacientes a los seis meses de inicio del soporte nutricional. Material y métodos: se confeccionó un formulario con datos personales, enfermedad de base, enfermedad actual, laboratorio al ingreso y a los seis meses, complicaciones inmediatas y tardías. Se implementó el soporte nutricional domiciliario a trav{es de una fórmula artesanal. El método de administración fue en bolos y con jeringa. El seguimiento se realizó a través de contactos telefónicos y visitas periódicas al hospital para la evaluación clínica y nutricional. Resultados: se evaluaron un total de dieciseis pacientes (once hombres, cinco mujeres)...
Subject(s)
Humans , Enteral Nutrition , GastrostomyABSTRACT
La Gastrostomía Endoscópica Percutánea (PEG) es un método rápido y seguro de acceso a la alimentación enteral en pacientes de alto riesgo para ser sometidos a una gastrostomía abierta y que requieran de nutrición enteral prolongada con el fin de lograr un adecuado soporte nutricional. El objetivo de este estudio fue evaluar la tolerancia en el uso de la PEG, medir las complicaciones inmediatas y tardías y evaluar el estado nutricional de los pacientes a los seis meses de inicio del soporte nutricional. Material y métodos: se confeccionó un formulario con datos personales, enfermedad de base, enfermedad actual, laboratorio al ingreso y a los seis meses, complicaciones inmediatas y tardías. Se implementó el soporte nutricional domiciliario a trav{es de una fórmula artesanal. El método de administración fue en bolos y con jeringa. El seguimiento se realizó a través de contactos telefónicos y visitas periódicas al hospital para la evaluación clínica y nutricional. Resultados: se evaluaron un total de dieciseis pacientes (once hombres, cinco mujeres)...(AU)
Subject(s)
Humans , Gastrostomy , Enteral NutritionABSTRACT
The experience in upper G.I. tract hemorrhage accumulated during the first 30 months in the Emergency Hemorrhage Unit at the Hospital Posadas is here reported over a total of 428 endoscopies, we found 518 lesions. Ninety one (21%) presented with active bleeding, and 317 (76%) were considered as the probable cause of the bleeding. In 37 cases (8.6%) the site of bleeding was detected, but the diagnosis wasn't done. The most frequent lesions were erosive gastritis (21.2%), gastric ulcer (20%), erosive duodenitis (12.6%), duodenal ulcer (12.15%) and esophageal varices (12.12%) the diagnosis was normal 14.7% of the cases. One hundred and sixty one patients were admitted to the hospital; on 143 (88.82%) patients the original diagnosis was confirmed but it was modified in 18 patients (11.18%) by surgery or repeated endoscopy. During the last 20 months of the period the accuracy diagnostic of the endoscopy increased 95%. When compared with the first 10 months (76%) this fact shows, the importance of the experience acquired by the endoscopist. Most of the patients received medical treatment with a mortality of 9.02% and 25 patients received surgical treatment with a mortality of 28%.
Subject(s)
Emergencies , Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Adolescent , Adult , Aged , Duodenitis/complications , Esophageal and Gastric Varices/complications , Female , Gastritis/complications , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Peptic Ulcer/complicationsSubject(s)
Child , Adolescent , Adult , Middle Aged , Aged , Humans , Emergencies , Endoscopy , Gastrointestinal Hemorrhage , Gastrointestinal Diseases , Peptic UlcerSubject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Emergencies , Endoscopy , Gastrointestinal Hemorrhage , Gastrointestinal Diseases , Peptic UlcerABSTRACT
The experience in upper G.I. tract hemorrhage accumulated during the first 30 months in the Emergency Hemorrhage Unit at the Hospital Posadas is here reported over a total of 428 endoscopies, we found 518 lesions. Ninety one (21
) presented with active bleeding, and 317 (76
) were considered as the probable cause of the bleeding. In 37 cases (8.6
) the site of bleeding was detected, but the diagnosis wasnt done. The most frequent lesions were erosive gastritis (21.2
), gastric ulcer (20
), erosive duodenitis (12.6
), duodenal ulcer (12.15
) and esophageal varices (12.12
) the diagnosis was normal 14.7
of the cases. One hundred and sixty one patients were admitted to the hospital; on 143 (88.82
) patients the original diagnosis was confirmed but it was modified in 18 patients (11.18
) by surgery or repeated endoscopy. During the last 20 months of the period the accuracy diagnostic of the endoscopy increased 95
. When compared with the first 10 months (76
) this fact shows, the importance of the experience acquired by the endoscopist. Most of the patients received medical treatment with a mortality of 9.02
and 25 patients received surgical treatment with a mortality of 28
.
