Low applicability of the ‘‘six-and-twelve score” in hepatocellular carcinomatreated with drug-eluting bead transarterial chemoembolization

Objective: the effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) dependson the selection of suitable patients. The ‘‘six-and-twelve score” distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with drug-eluting beads (DEB)-TACE.Methods: an observational, retrospective, unicentric study with consecutive compensated patients treated with DEBTACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation.Results: a total of 225 consecutive HCC patients were included; BCLC-0/A, n = 131 (single nodules > 5, n = 29) andBCLC-B, n = 94. Median overall survival (OS) was 27 months (95 % CI, 23.8-30.2). OS was different between BCLC-0/A and BCLC-B: 30 vs. 24 months (p = 0.03), Child-Pugh A5 vs. A6-B7: 30 vs. 27 months (p = 0.003). ‘‘Six-and-twelve score” groups discriminated OS: group 1, n = 123, 32 months (95 % CI, 27.5-63.5); group 2, n = 101, 24 months (95% CI, 19.6-28.4); and group 3, n = 1, 27 months (p = 0.024). When comparing the three scores, the ‘‘six-and-twelve score” showed the best discrimination power: C-index, 0.603; Akaike’s informationcriterion (AIC), 1.642; likelihood ratio test (LRT), 16.21.Conclusion: The ‘‘six-and-twelve score” is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score > 12) and no differences were observed with BCLC, therefore applicability is limited. (AU)

Low applicability of the ''Six-and-twelve score" in hepatocellular carcinoma treated with Drug-Eluting Beads Transarterial Chemoembolization.

OBJECTIVE: The effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) depends on the selection of suitable patients. The ''Six-and-twelve score" distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with Drug-Eluting Beads (DEB)-TACE. METHODS: Observational, retrospective, unicentric study with consecutive compensated patients treated with DEB-TACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation. RESULTS: 225 HCC consecutive patients were included; BCLC-0/A n=131 (single nodules > 5, n=29) and BCLC-B n=94. The median overall survival (OS) was 27 months (95% CI 23.8-30.2). OS was different between BCLC-0/A vs BCLC-B: 30 vs 24 months (p= 0.03), Child-Pugh A5 vs A6-B7: 30 vs 27 months (p= 0.003). ''Six-and-twelve score" groups discriminated OS: group 1, n=123, 32 months (95% CI 27.5-63.5), group 2, n=101, 24 months (95% CI 19.6-28.4) and group 3, n=1, 27 months (p=0.024). When comparing the three scores, the ''Six-and-twelve score" showed the best discrimination power: C-index 0.603, Akaike's information criterion (AIC) 1.642, likelihood ratio test (LRT) 16.21. CONCLUSION: The ''Six-and-twelve score" is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score >12) and no differences were observed with BCLC, therefore its applicability is limited. .

Triptófano como suplemento dietético y tratamiento de los sofocos, la astenia y el insomnio en el cáncer / L-tryptophan as dietetic supplement and treatment for hot flashes, astenia, and insomnia in cancer patients

Introducción: tanto en las mujeres con cáncer de mama y cáncer ginecológico como en los hombres con carcinoma prostático, los sofocos, la astenia y el insomnio son síntomas frecuentes y molestos que alteran la calidad de vida. Objetivo: evaluar la eficacia del aporte de triptófano como tratamiento de los sofocos, la astenia y el insomnio en pacientes con cáncer de próstata, de mama y cervicouterino. Materiales y métodos: estudio de intervención sin grupo de control en el Servicio de Oncología Radioterápica del HUCA, en el período de julio de 2018 a julio de 2019. Se incluyeron en total 60 pacientes con cáncer de próstata, de mama y cervicouterino que habían recibido tratamiento con radioterapia y hormonoterapia, y que presentaban sofocos, astenia e insomnio. Se administraron 3 g de L-triptófano al día. Resultados: se reportan un aumento significativo del valor del triptófano sérico al final del estudio (p < 0,001) y una disminución significativa de las puntuaciones de los síntomas estudiados; aunque no hemos hallado ninguna significación estadística entre ellos, sí se aprecia una mejoría significativa de cada uno de los síntomas, así como una mejoría de la calidad de vida (p < 0,001). Conclusiones: el estudio actual sugiere que, en los pacientes con cáncer de mama, de próstata o cervicouterino y síntomas de sofocos, astenia e insomnio, el aporte de triptófano como suplemento nutricional se tolera bien, mejora la calidad de vida y puede asociarse a una mejoría de los valores obtenidos en las escalas de los síntomas referidos, aunque no se demuestra ninguna relación estadísticamente significativa con la elevación del triptófano en sangre. (AU)

Introduction: in women with breast cancer and gynecologic cancer, as well as in men with prostate carcinoma, hot flashes, asthenia, and insomnia are common and bothersome symptoms that impair quality of life. Objective: to evaluate the effectiveness of tryptophan intake as a treatment for hot flushes, asthenia, and insomnia in patients with prostate, breast, and uterine cervical cancer. Materials and methods: intervention study without a control group at the HUCA Radiation Oncology Service, from July 2018 to July 2019. A total of 60 patients with prostate, breast, or uterine cervical cancer who had received treatment with radiotherapy and hormone therapy, and who presented with hot flushes, asthenia, and insomnia were included. L-tryptophan was administered at a dose of 3 g per day. Results: a significant increase in serum tryptophan levels at the end of the study (p < 0.001) and a significant decrease in the scores of the study symptoms were reported. Although statistical significance was not found, a significant improvement in each symptom was observed, as well as an improvement in quality of life (p < 0.001). Conclusions: the study suggests that, in patients with breast, prostate, or uterine cervical cancer, and symptoms such as hot flushes, asthenia, and insomnia, the administration of tryptophan as a nutritional supplement is well tolerated, improves quality of life, and is associated with improvement in the scale scores of the symptoms of interest, although no statistically significant relationship with increased blood tryptophan levels was found. (AU)

[L-tryptophan as dietetic supplement and treatment for hot flashes, astenia, and insomnia in cancer patients]. / Triptófano como suplemento dietético y tratamiento de los sofocos, la astenia y el insomnio en el cáncer.

INTRODUCTION: Introduction: in women with breast cancer and gynecologic cancer, as well as in men with prostate carcinoma, hot flashes, asthenia, and insomnia are common and bothersome symptoms that impair quality of life. Objective: to evaluate the effectiveness of tryptophan intake as a treatment for hot flushes, asthenia, and insomnia in patients with prostate, breast, and uterine cervical cancer. Materials and methods: intervention study without a control group at the HUCA Radiation Oncology Service, from July 2018 to July 2019. A total of 60 patients with prostate, breast, or uterine cervical cancer who had received treatment with radiotherapy and hormone therapy, and who presented with hot flushes, asthenia, and insomnia were included. L-tryptophan was administered at a dose of 3 g per day. Results: a significant increase in serum tryptophan levels at the end of the study (p < 0.001) and a significant decrease in the scores of the study symptoms were reported. Although statistical significance was not found, a significant improvement in each symptom was observed, as well as an improvement in quality of life (p < 0.001). Conclusions: the study suggests that, in patients with breast, prostate, or uterine cervical cancer, and symptoms such as hot flushes, asthenia, and insomnia, the administration of tryptophan as a nutritional supplement is well tolerated, improves quality of life, and is associated with improvement in the scale scores of the symptoms of interest, although no statistically significant relationship with increased blood tryptophan levels was found.

INTRODUCCIÓN: Introducción: tanto en las mujeres con cáncer de mama y cáncer ginecológico como en los hombres con carcinoma prostático, los sofocos, la astenia y el insomnio son síntomas frecuentes y molestos que alteran la calidad de vida. Objetivo: evaluar la eficacia del aporte de triptófano como tratamiento de los sofocos, la astenia y el insomnio en pacientes con cáncer de próstata, de mama y cervicouterino. Materiales y métodos: estudio de intervención sin grupo de control en el Servicio de Oncología Radioterápica del HUCA, en el período de julio de 2018 a julio de 2019. Se incluyeron en total 60 pacientes con cáncer de próstata, de mama y cervicouterino que habían recibido tratamiento con radioterapia y hormonoterapia, y que presentaban sofocos, astenia e insomnio. Se administraron 3 g de L-triptófano al día. Resultados: se reportan un aumento significativo del valor del triptófano sérico al final del estudio (p < 0,001) y una disminución significativa de las puntuaciones de los síntomas estudiados; aunque no hemos hallado ninguna significación estadística entre ellos, sí se aprecia una mejoría significativa de cada uno de los síntomas, así como una mejoría de la calidad de vida (p < 0,001). Conclusiones: el estudio actual sugiere que, en los pacientes con cáncer de mama, de próstata o cervicouterino y síntomas de sofocos, astenia e insomnio, el aporte de triptófano como suplemento nutricional se tolera bien, mejora la calidad de vida y puede asociarse a una mejoría de los valores obtenidos en las escalas de los síntomas referidos, aunque no se demuestra ninguna relación estadísticamente significativa con la elevación del triptófano en sangre.

The development of early ascites is associated with shorter overall survival in patients with hepatocellular carcinoma treated with drug-eluting embolic chemoembolization.

BACKGROUND: A single-centre cohort study was performed to identify the independent factors associated with the overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). METHODS: A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with overall survival after DEB-TACE, stressing the role of post-TACE events, was performed. RESULTS: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, tumor size, AFP < 100 ng/mL and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. CONCLUSIONS: Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.

Miositis carcinomatosa secundaria a cáncer gástrico / Carcinomatous myositis secondary to gastric cancer

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Ameliorative effect of black grape juice on systemic alterations and mandibular osteoradionecrosis induced by whole brain irradiation in rats.

PURPOSE: Whole brain irradiation (WBI) causes a variety of secondary side-effects including anorexia and bone necrosis. We evaluated the radiomodifying effect of black grape juice (BGJ) on WBI alterations in rats measuring food and water intake, body weight, hemogram, and morphological and histological mandibular parameters. MATERIALS AND METHODS: Forty male rats (200-250 g) were exposed to eight sessions of cranial X-ray irradiation. The total dose absorbed was 32 Gy delivered over 2 weeks. Four groups were defined: (i) NG: non-irradiated, glucose and fructose solution-supplemented (GFS); (ii) NJ: non-irradiated, BGJ-supplemented; (iii) RG: irradiated, GFS-supplemented; and (iv) RJ: irradiated, BGJ-supplemented. Rats received daily BGJ or GFS dosing by gavage starting 4 days before, continuing during, and ending 4 days after WBI. RESULTS: RJ rats ingested more food and water and showed less body weight loss than RG rats during the irradiation period. Forty days after WBI, irradiated animals started losing weight again compared with controls as a consequence of masticatory hypofunction by mandibular osteoradionecrosis (ORN). Osteoclastic activity and inflammation were apparent in RG rat mandibles. BGJ was able to attenuate the severity of ORN as well as to improve white and red blood cell counts. CONCLUSIONS: Fractionated whole brain irradiation induces mandibular changes that interfere with normal feeding. BGJ can be used to mitigate systemic side-effects of brain irradiation and ORN.

Analysis of endovascular treatment of ruptured aneurysms of the middle cerebral artery compared to other anatomical locations.

OBJECTIVE: The objective of this article is to compare the results of endovascular treatment of ruptured middle cerebral artery (MCA) aneurysms with ruptured aneurysms of other anatomic locations. METHODS: Fifty consecutive ruptured aneurysms of the MCA and 209 aneurysms at other anatomical locations were selected retrospectively. We compared epidemiological, clinical and radiological variables, prognosis and complications. RESULTS: The MCA aneurysms had a greater size and a poor dome/neck ratio. There were no significant differences in endovascular technique complications, occlusion rate or rebleeding between the two groups (p > 0.1). There were no significant differences in the mortality and number of dependent patients after one month. CONCLUSION: The endovascular treatment of ruptured MCA aneurysms without hematoma is as safe and effective as other aneurysm localizations. Complication rates, occlusion rates and rebleeding of ruptured MCA aneurysms are comparable to other locations.

Temporomandibular disorder or not? A case report.

OBJECTIVES: The purpose of this case study is to show the need for a good differential diagnosis of suspected temporomandibular disorder (TMD) with otologic symptoms. METHODS/RESULTS: This study is a clinical case referring to a patient seeking treatment for pain in the right maxilla. The usual Medical History for diagnosis of a TMD was applied. Anamnesis revealed the patient had had a right maxillary pain for one month, a slight hearing loss and dizziness for the past five to six months, and two implants placed in the upper jaw two years previously. Clinical examination showed right temporomandibular joint (TMJ) clicking and tenderness in the lateral pterygoid muscles and in the right masseter muscle. Temporomandibular disorder and orofacial pain were diagnosed, and the appropriate treatment was initiated. In addition, a cranial magnetic resonance imaging (MRI) evaluation was requested and revealed acoustic neuroma. CONCLUSION: The coexistence of TMD with otovestibular symptoms suggests the need for a cranial MRI evaluation, especially if the dental or TMD treatment has not been positive.

Anatomical results, rebleeding and factors that affect the degree of occlusion in ruptured cerebral aneurysms after endovascular therapy.

OBJECT: To present a series of ruptured cerebral aneurysms in consecutive non-selected patients treated with endovascular therapy, analyzing the initial degree of occlusion, its anatomical evolution mid-term and the variables that could statistically affect them. METHODS: 251 aneurysms were first treated with coiling (embolization). 203 patients were followed up with conventional angiography for 6-8 months after the initial treatment and 182 were followed up with three-dimensional time of flight MR angiography at 18-24 months. Postoperative and mid-term anatomical results were evaluated anonymously and independently using the modified Montreal Scale. RESULTS: The initial rate of complete occlusion was 70.9%, with rates of neck remnants and aneurysm remants of 18.3% and 10.7%, respectively. The recurrence rate was 13% after 6 months and 2% between 6 months and 2 years. The rate of retreatment was 11%. Statistically, the variables that were found to be related to the initial degree of occlusion were the use of a remodeling balloon technique (p=0.012), the size of the aneurysm neck (p=0.044) and the size of the aneurysm (p=0.004). The recanalization rate at mid-term depended on the size of the aneurysm. Although aneurysms with partial occlusion initially tended to evolve to a worse degree of closure than those with complete occlusion initially, the relationship was not statistically significant (p=0.110). CONCLUSIONS: Embolized aneurysms can develop a worse degree of closure even when the initial occlusion is complete. The degree of occlusion depends directly on morphological factors and the use of balloon-assisted techniques. The recanalization rate at mid-term depends on the size of the aneurysm and probably on the density of the packing achieved with the initial treatment.

[Sarcoidosis presenting as partial seizures. Report of one case]. / Crisis epiléptica como primera manifestación de sarcoidosis. Caso clínico.

The nervous system is affected in 10% of patients with sarcoidosis. However, neurological disturbances are rarely the first manifestation of the disease. We report a 36-year-old woman presenting with partial seizures that generalized secondarily. Magnetic resonance showed a left parietal cortical-subcortical lesion with a minimal mass effect, moderate vasogenic edema and intense enhancement with intravenous contrast. A magnetic resonance spectroscopy disclosed a low aggressiveness profile, compatible with an inflammatory lesion. Angiotensin converting enzyme levels were normal. The lesion was excised and the pathological study showed the presence of granulomas with dubious necrosis. The patient was treated with antituberculous drugs. One year later, the lesion had grown and a thorax CT scan showed numerous mediastinal and hilar lymphadenopathies. A new determination of angiotensin converting enzyme disclosed elevated levels and the biopsy of mediastinal lymph nodes confirmed the presence of sarcoidosis.

Crisis epiléptica como primera manifestación de sarcoidosis: caso clínico / Sarcoidosis presenting as partial seizures: report of one case

The nervous system is affected in 10 percent of patients with sarcoidosis. However, neurological disturbances are rarely the frst manifestation of the disease. We report a 36-year-old woman presenting with partial seizures that generalized secondarily. Magnetic resonance showed a left parietal cortical-subcortical lesion with a minimal mass effect, moderate vasogenic edema and intense enhancement with intravenous contrast. A magnetic resonance spectroscopy disclosed a low aggressiveness profle, compatible with an infammatory lesion. Angiotensin converting enzyme levels were normal. The lesion was excised and the pathological study showed the presence of granulomas with dubious necrosis. The patient was treated with antituberculous drugs. One year later, the lesion had grown and a thorax CT scan showed numerous mediastinal and hilar lymphadenopathies. A new determination of angiotensin converting enzyme disclosed elevated levels and the biopsy of mediastinal lymph nodes confrmed the presence of sarcoidosis.