ABSTRACT
Our objective is to assess treatment efficacy, safety and pattern of response and recurrence in patients with recurrent high-grade glioma treated with bevacizumab and irinotecan. We reviewed retrospectively 51 patients with recurrent high-grade glioma treated with this combination at the Henry Ford Hermelin Brain Tumor Center from 11/15/2005 to 04/01/2008. The 6-month progression-free survival (PFS) for anaplastic gliomas (AGs) was 78.6 and 63.7% for glioblastoma. The median PFS was 13.4 months for AG and 7.6 months for those with glioblastoma. The overall survival rate (OS) at 6 months was 85.7% for AG and 78.0% for glioblastoma. The 12-month OS was 77.9% for AG and 42.6% for glioblastoma. The median OS time for AGs was not reached and was 11.5 months for those with glioblastoma. Thirty-six out of 51 (70.59%) patients demonstrated partial (32/51) or complete (4/51) radiographic response to treatment and 8/51 (15.69%) remained stable. Of the 38 who demonstrated progression on post-gadolinium studies, 23 showed distant progression with or without local recurrence. Seven patients showed progression on FLAIR without concordant findings on post-Gd sequences. Six patients (11.76%) discontinued treatment due to a treatment-emergent adverse event, including one with end-stage renal failure and another with gastric perforation. No symptomatic intracranial hemorrhages were reported. Patients with recurrent high-grade glioma treated with bevacizumab plus irinotecan demonstrate an excellent radiographic response rate and improved clinical outcome when compared to historical data. The high rate of distant tumor progression suggests that tumors may adapt to inhibition of angiogenesis by increased infiltration and vascular co-option.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents, Phytogenic/therapeutic use , Brain Neoplasms/drug therapy , Camptothecin/analogs & derivatives , Glioma/drug therapy , Adult , Aged , Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Antineoplastic Agents, Phytogenic/adverse effects , Bevacizumab , Brain Neoplasms/pathology , Camptothecin/adverse effects , Camptothecin/therapeutic use , Disease-Free Survival , Drug Therapy, Combination , Female , Follow-Up Studies , Glioma/pathology , Humans , Irinotecan , Magnetic Resonance Imaging/methods , Male , Middle Aged , Retrospective Studies , Survival Analysis , Time Factors , Treatment Outcome , Young AdultABSTRACT
La aplicación del sistema de información geográfico en la vigilancia epidemiológica permite definir en forma actualizada el marco físico y epidemiológico, en donde el servicio agrícola y ganadero ejerce su acción preventiva de vigilancia y control en campos de pastoreo cordilleranos. El conocimiento de la población expuesta y su distribución en ese medio geográfico premiten estabelecer una herramienta de gran valor en el manejo de una emergencia sanitaria. Los servicios veterinarios de los países deben considerar la aplicación de esta tecnología en epidemiología veterinaria, según sus necesidades de manejo de información.
Subject(s)
Epidemiological Monitoring , Geographic Information Systems , Veterinary Public Health , Health Surveillance , ChileABSTRACT
The noma has been rarely seen during these last decades. It is of an infections etiology, primarily affecting malnourished or immunodeficient children. It is easily confused with neoplastic tumors, tuberculosis, mycosis or gangrene ecthyma which may condition errors in treatment with severe undesirable side-effects. It has recently been associated to AIDS. A case is reported, comments are included on the diagnostic method, medical and surgical treatment and the results obtained.
