ABSTRACT
Malignant hemorrhagic ascites may complicate the terminal evolution of digestive cancers with peritoneal carcinomatosis. It has a bad influence on prognosis and may severely impair patients' quality of life. Palliative laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed to treat debilitating malignant ascites. Two cases of peritoneal carcinomatosis causing hemorrhagic ascites and severe anemia that needed iterative blood transfusions are reported. These patients were treated by laparoscopic HIPEC (mitomycin C and cisplatin with an inflow temperature of 43°C), resulting in cessation of peritoneal bleeding. No postoperative complication or relapse of ascites occurred during the following months. No more blood transfusion was needed. Laparoscopic HIPEC might be an effective and safe therapeutic option to consider in patients with malignant hemorrhagic ascites.
ABSTRACT
Assessment of liver fibrosis is of paramount importance to guide the therapeutic strategy in patients with chronic hepatitis C (CHC). In this pilot study, we investigated the potential of serum Fourier transform infrared (FTIR) spectroscopy for differentiating CHC patients with extensive hepatic fibrosis from those without fibrosis. Twenty-three serum samples from CHC patients were selected according to the degree of hepatic fibrosis as evaluated by the FibroTest: 12 from patients with no hepatic fibrosis (F0) and 11 from patients with extensive fibrosis (F3-F4). The FTIR spectra (ten per sample) were acquired in the transmission mode and data homogeneity was tested by cluster analysis to exclude outliers. After selection of the most discriminant wavelengths using an ANOVA-based algorithm, the support vector machine (SVM) method was used as a supervised classification model to classify the spectra into two classes of hepatic fibrosis, F0 and F3-F4. Given the small number of samples, a leave-one-out cross-validation algorithm was used. When SVM was applied to all spectra (n = 230), the sensitivity and specificity of the classifier were 90.1% and 100%, respectively. When SVM was applied to the subset of 219 spectra, i.e., excluding the outliers, the sensitivity and specificity of the classifier were 95.2% and 100%, respectively. This pilot study strongly suggests that the serum from CHC patients exhibits infrared spectral characteristics, allowing patients with extensive fibrosis to be differentiated from those with no hepatic fibrosis.
Subject(s)
Biomarkers/blood , Hepatitis C, Chronic/blood , Liver Cirrhosis/blood , Liver Cirrhosis/pathology , Liver/pathology , Spectroscopy, Fourier Transform Infrared/methods , Adult , Aged , Female , France , Hepacivirus/physiology , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/pathology , Hepatitis C, Chronic/virology , Humans , Liver/virology , Liver Cirrhosis/etiology , Liver Cirrhosis/virology , Male , Middle Aged , Pilot Projects , Retrospective Studies , Sensitivity and Specificity , Severity of Illness Index , Support Vector MachineABSTRACT
BACKGROUNDS: The combination gemcitabine-oxaliplatin (GEMOX) is frequently used in patients with advanced biliary tract carcinoma (BTC). However, this is only based on phase II studies performed in selected patients.We assessed the efficacy and safety of the GEMOX regimen in non-selected patients with advanced BTC. METHODS: All consecutive patients with advanced BTC received the GEMOX regimen in a setting outside a study: gemcitabine 1,000 mg/m(2) on day 1, and oxaliplatin 100 mg/m(2) on day 2, treatment repeated every 2 weeks until progression or unacceptable toxicity. RESULTS: Forty-four patients were enrolled. EFFICACY: 1 complete and 6 partial responses (objective response rate = 16.3%), 18 tumour stabilizations (41.9%, disease control rate = 58.1%), median progression-free survival was 5.0 months and median overall survival was 11.0 months. TOXICITY: grade 3 neuropathy in 4 patients, grade 3 asthenia in 5 patients. CONCLUSION: The GEMOX combination was well tolerated, with a modest activity in non-selected patients with advanced BTC. This regimen should be compared to the new standard gemcitabine-cisplatin combination.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Biliary Tract Neoplasms/drug therapy , Carcinoma/drug therapy , Adult , Aged , Aged, 80 and over , Biliary Tract Neoplasms/mortality , Biliary Tract Neoplasms/pathology , Carcinoma/mortality , Carcinoma/pathology , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Disease-Free Survival , Female , Follow-Up Studies , Humans , Male , Middle Aged , Organoplatinum Compounds/administration & dosage , Treatment OutcomeABSTRACT
Fourier transform infrared (FTIR) spectroscopy is nowadays widely accepted as a technique with high potential for diagnosis of cancerous tissues. This study presents an example of the investigation of peritoneal metastases by FTIR microimaging. Peritoneal malignancies are generally secondary localizations of primary visceral cancers such as ovarian, stomach or colon cancers. By analysing simultaneously both formalin-fixed paraffin-embedded and frozen specimens, we examined malignant and non-malignant (i.e. fibrotic and cicatricial) peritoneal lesions. Paraffin-embedded tissues were analysed without any previous dewaxing. Multivariate statistical approaches, based on the classification of infrared data by hierarchical cluster analysis, allowed the discrimination of these various samples. Microimaging also permits the revelation of the heterogeneity of the tissue: it was possible to localize precisely the cancerous areas, and to distinguish, on the basis of their spectral signatures, the peritumoral neighbouring connective tissue close to the carcinomatous areas from the connective tissue distant from the cancerous areas. These spectral differences could be useful as complementary information to study molecular changes associated with the malignancy.
