ABSTRACT
PURPOSE: To determine the importance of downstaging of locally advanced rectal cancer after neoadjuvant treatment. METHODS AND MATERIALS: The study included all consecutive patients with locally advanced rectal cancer who underwent neoadjuvant treatment (chemotherapy and/or radiotherapy) in different Italian centers from June 1996 to December 2003. A novel score was used, calculated as the sum of numbers obtained by giving a negative or positive point, respectively, to each degree of increase or decrease in clinical to pathologic T and N status. RESULTS: A total of 317 patients were eligible for analysis. Neoadjuvant treatments performed were as follows: radiotherapy alone in 75 of 317 patients (23.7%), radiotherapy plus chemotherapy in 242 of 317 patients (76.3%). Worse disease-free survival was observed in patients with a lower score (Score 1 = -3 to +3 vs. Score 2 = +4 to +7; p = 0.04). CONCLUSIONS: Our results suggest that a novel score, calculated from preoperative and pathologic tumor and lymph node status, could represent an important parameter to predict outcome in patients receiving neoadjuvant treatment for rectal cancer. The score could be useful to select patients for adjuvant chemotherapy after neoadjuvant treatment and surgery.
Subject(s)
Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Neoplasm Staging , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Analysis of Variance , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Disease-Free Survival , Female , Humans , Italy , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging/methods , Rectal Neoplasms/mortality , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Remission Induction/methods , Treatment OutcomeABSTRACT
BACKGROUND AND AIMS: To evaluate the feasibility in clinical practice of alternating chemo-radiotherapy in locally advanced head and neck cancer patients. PATIENTS AND METHODS: From August 1993 to April 1998 at the Division of Medical Oncology of Parma, 48 consecutive patients were observed, and 38 (79%) started the Merlano chemo-radiotherapy. The characteristics of the patients were: males (32, 84%); median age, 57 years; PS <2 (32, 84%). The primary sites were the oropharynx (18, 47%), oral cavity (8, 21%), hypopharynx (7, 19%), larynx (5, 13%); stage IV disease was present in 29 (76%) patients. Twenty-five (66%) patients were married, and 24 (63%) resided outside of the city. RESULTS: The compliance was very low: 21 patients (55%) performed all the programmed cycles of chemotherapy, whereas only 5 patients (13%) performed the chemo-radiotherapy at full doses without any delay. The objective responses were 3 (8%) complete and 21 (55%) complete plus partial responses. Failures were 2 (5%) stable disease and 2 (5%) progressive disease, and the response was not assessable in 10 (26%). The median duration of the response was 8 months. The median overall survival and the time to progression were 18 and 13 months, respectively; the 5-year overall and relapse-free survival were 36% and 26%, respectively. Nine (24%) patients were still alive as of August 30, 2001, 8 (21%) of them without progression. Twenty-six patients (68%) died with a local-regional relapse. One patient (3%) died for a second cancer. Grade 3-4 hematologic toxicity was leukopenia (n = 25, 66%) and thrombocytopenia (n = 9, 24%); grade 3-4 non-hematologic toxicity was diarrhea (n = 3, 8%) and mucositis (n = 2, 5%). Two patients (5%) died for intestinal infarction and perforation possibly related to treatment. CONCLUSIONS: Compliance to the chemo-radiotherapy was very poor. The response rate was lower than that reported in clinical trials, whereas overall survival was comparable. The alternating chemo-radiotherapy is a very complex treatment that cannot be easily applied in clinical practice; a careful selection of patients is mandatory not only considering oncologic and medical criteria, but also the level of awareness of the patient and his family.
Subject(s)
Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Patient Compliance , Adult , Aged , Chemotherapy, Adjuvant/adverse effects , Disease-Free Survival , Drug Administration Schedule , Female , Follow-Up Studies , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Neoplasm Staging , Patient Compliance/statistics & numerical data , Radiotherapy, Adjuvant/adverse effects , Randomized Controlled Trials as Topic , Survival Analysis , Treatment OutcomeABSTRACT
La Actinomycosis es una infección bacteriana que puede afectar cualquier sitio del organismo. Una variedad de organismos gram-positivos, no esporulados, anaerobios o microaerófilos, principalmente del género Actinomyces, son los agentes responsables. A pesar de las lesiones orales y cervicofaciales las más frecuentemente observadas, la Actynomicosis abdominal es probablemente el mayor desafío diagnóstico, debido a lo inespecífico de los síntomas. Caso Clínico: una mujer de 73 años de edad fue admitida en el hospital por presentar fiebre, pérdida de peso, dolor en hipocondrio derecho e ictericia de 7 días de evolución. Una ecografía hepática mostró múltiples abscesos hepáticos; se realizó aspiración con aguja fina guiada ecográficamente obteniendo material purulento del que se aisló Actimonyces sp. La paciente evolucionó favorablemente, tratada con drenaje percutáneo y altas dosis de Penicilina parenteral durante cuatro semanas, seguida de Amoxicilina 1500 mg/d. El conocimiento del amplio espectro de manifestaciones de esta enfermedad permitirá un diagnóstico y tratamiento rápidos, minimizando así la morbilidad y mortalidad que tan frecuentemente ocurren con la Actinomycosis.
Subject(s)
Humans , Female , Aged , Liver Abscess , Actinomycosis/diagnosis , Actinomycosis/mortality , Actinomycosis/therapy , Bacterial Infections/diagnosis , Liver , Actinomyces/isolation & purification , Amoxicillin/therapeutic use , Biopsy, Needle , Drainage , Infusions, Parenteral , Penicillins/therapeutic useABSTRACT
La Actinomycosis es una infección bacteriana que puede afectar cualquier sitio del organismo. Una variedad de organismos gram-positivos, no esporulados, anaerobios o microaerófilos, principalmente del género Actinomyces, son los agentes responsables. A pesar de las lesiones orales y cervicofaciales las más frecuentemente observadas, la Actynomicosis abdominal es probablemente el mayor desafío diagnóstico, debido a lo inespecífico de los síntomas. Caso Clínico: una mujer de 73 años de edad fue admitida en el hospital por presentar fiebre, pérdida de peso, dolor en hipocondrio derecho e ictericia de 7 días de evolución. Una ecografía hepática mostró múltiples abscesos hepáticos; se realizó aspiración con aguja fina guiada ecográficamente obteniendo material purulento del que se aisló Actimonyces sp. La paciente evolucionó favorablemente, tratada con drenaje percutáneo y altas dosis de Penicilina parenteral durante cuatro semanas, seguida de Amoxicilina 1500 mg/d. El conocimiento del amplio espectro de manifestaciones de esta enfermedad permitirá un diagnóstico y tratamiento rápidos, minimizando así la morbilidad y mortalidad que tan frecuentemente ocurren con la Actinomycosis. (AU)
