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1.
Acta Oncol ; 51(8): 1020-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22616951

RESUMO

BACKGROUND: To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients. MATERIAL AND METHODS: Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy - General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZ(M)). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS). RESULTS: Patients' median survival time was 35 months (95% CI 28.9-41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979-0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival. CONCLUSION: HRQOL has incremental predictive value for long-term survival in cancer patients.


Assuntos
Nível de Saúde , Neoplasias/mortalidade , Neoplasias/radioterapia , Qualidade de Vida , Estresse Psicológico/etiologia , Adulto , Idoso , Escolaridade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Estado Civil , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Neoplasias/patologia , Neoplasias/psicologia , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais
2.
JOP ; 7(1): 34-40, 2006 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-16407616

RESUMO

CONTEXT: Primary resectability is expected in up to 20% of pancreatic cancer patients. While most patients relapse with distant metastases, approximately 30% of patients show isolated local recurrence without evidence of distant metastases. OBJECTIVE: The present analysis investigates the efficacy of chemoradiotherapy in this particular patient group. DESIGN: Retrospective study. PATIENTS: Eighteen consecutive pancreatic cancer patients presenting with isolated locoregional recurrence after surgical resection. The median interval between primary surgery and diagnosis of local recurrence was 10.4 months (range: 2.0-19.3 months). INTERVENTIONS: Patients received 3-D conformal radiation with 45 Gy in 25 fractions of 1.8 Gy/day. Simultaneous chemotherapy was employed either with continuous 5-FU infusion, partly in combination with gemcitabine, or with gemcitabine and cisplatin. Sequential chemotherapy with gemcitabine and cisplatin was given to some patients before and after the chemoradiotherapy. RESULTS: In 17 of the 18 patients included, radiotherapy was employed at the intended dose. While WHO grade 3-4 gastrointestinal toxicity was not reported, hematotoxicity was more pronounced. Grades 3 and 4 leukocytopenia occurred in 4 patients (22.2%) and 1 (5.6%) patient, respectively, and grades 3 and 4 thrombocytopenia occurred in 4 patients (22.2%) and 1 patient(5.6%), respectively. Six (37.5%) complete remissions, 6 (37.5%) partial remissions, and 4 (25.0%) stable diseases were noted in 16 evaluable patients. Median progression-free survival calculated from the start of the chemoradiotherapy was 14.7 months (range: 8.4-21.0 months) . Seven (28.9%) patients had another local relapse, while 11 (61.1%) patients developed distant metastases. Median overall survival from the start of the chemoradiotherapy was 17.5 months (95% CI: 15.6-19.4 months) and median survival from the initial diagnosis was 27.2 months (95% CI: 23.9-30.6 months). CONCLUSION: The data provide a first indication that chemoradiotherapy is feasible and may be an effective treatment option in those patients who present with local metastasis after primary surgery for pancreatic cancer.


Assuntos
Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/terapia , Neoplasias Pancreáticas/terapia , Radioterapia Conformacional , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Terapia Combinada/efeitos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Leucopenia/epidemiologia , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/radioterapia , Pâncreas/efeitos dos fármacos , Pâncreas/efeitos da radiação , Pâncreas/cirurgia , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirurgia , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia , Fatores de Tempo , Resultado do Tratamento , Gencitabina
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