RESUMEN
PURPOSE: Patients with recurrent glioblastoma (rGBM) have a poor prognosis, with survival ranging from 25 to 40 weeks. Antiangiogenic agents are widely used, showing a variable response. In this study, we explored the efficacy of carmustine plus bevacizumab (BCNU/Bev) for treating rGBM. METHODS/PATIENTS: In this study, we assessed 59 adult patients with histologically confirmed rGBM who were treated with BCNU/Bev as second-line regimen. The response rate (RR), progression-free survival (PFS) and overall survival (OS) were evaluated according to their molecular expression profile, including CD133 mRNA expression, MGMT methylation (pMGMT), PDGFR amplification, YKL40 mRNA expression, IDH1/2 condition, p53 and EGFRvIII mutation status. RESULTS: Median follow-up was 18.6 months, overall RR to the combination was 56.3%, and median PFS was 9.0 months (95% CI 8.0-9.9). OS from time of diagnosis was 21.0 months (95% CI 13.2-28.7) and from starting BCNU/Bev it was 10.7 months (95% CI 9.5-11.8). IDH1/2 mutations were found in 30.5% of the patients, pMGMT in 55.9% and high CD133 mRNA expression in 57.6%. Factors which positively affected PFS included performance status (p = 0.015), IDH+ (p = 0.05), CD133 mRNA expression (p = 0.009) and pMGMT+ (p = 0.007). OS was positively affected by pMGMT+ (p = 0.05). Meanwhile, YKL40 negatively affected PFS (p = 0.01) and OS (p = 0.0001). Grade ≥ 3 toxicities included hypertension (22%) and fatigue (12%). CONCLUSIONS: BCNU/Bev is a safe and tolerable treatment for rGBM. Patients with MGMT+/IDH+ derive the greatest benefit from the treatment combination in the second-line setting. Nonetheless, high YKL40 expression discourages the use of antiangiogenic therapy.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Carmustina/uso terapéutico , Glioblastoma/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Antígeno AC133/genética , Antígeno AC133/metabolismo , Adulto , Anciano , Inhibidores de la Angiogénesis/efectos adversos , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Bevacizumab/efectos adversos , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/mortalidad , Carmustina/efectos adversos , Proteína 1 Similar a Quitinasa-3/genética , Colombia , Metilasas de Modificación del ADN/metabolismo , Enzimas Reparadoras del ADN/metabolismo , Esquema de Medicación , Femenino , Genes erbB-1 , Genes p53 , Glioblastoma/irrigación sanguínea , Glioblastoma/genética , Glioblastoma/mortalidad , Humanos , Isocitrato Deshidrogenasa/genética , Masculino , Metilación , Persona de Mediana Edad , Mutación , Recurrencia Local de Neoplasia/irrigación sanguínea , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/mortalidad , Supervivencia sin Progresión , ARN Mensajero/metabolismo , Receptores del Factor de Crecimiento Derivado de Plaquetas/genética , Análisis de Supervivencia , Proteínas Supresoras de Tumor/metabolismo , Adulto JovenRESUMEN
BACKGROUND: The procedure of radical peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for peritoneal cancers. AIMS: To evaluate various outcomes in a cohort of patients with peritoneal tumors treated with HIPEC. METHODS: Twenty-four patients consecutively treated with radical peritonectomy plus HIPEC within the time frame of November 2007 to July 2010 were enrolled; 15 (62%) had tumors of appendicular origin, 4 (16.7%) had primary peritoneal tumors, 2 had ovarian carcinomas and there was one case of colon cancer, one carcinosarcoma and one hemangioendothelioma. Mean age was 53 years (range: 26-68) and median follow-up was 14.2 months (range: 1-32). Demographic data, histology, peritoneal cancer index (PCI), surgical procedure characteristics, recurrence-free survival (RFS), and overall survival (OS) were all evaluated. Short-term morbidity and mortality were also determined. RESULTS: Complete cytoreduction was achieved in 18 patients (75%). Mean PCI was 15 (<10: 41% and >10: 58%), and the median (range) for surgery duration, length of stay in the Intensive Care Unit, parenteral nutritional support, and hospital stay were 12,5 (7-20) hours, 11,4 (2-74) days, 13,8 (12-65) days, and 29,1 (10-90) days, respectively. One patient (4%) died 6 months after the procedure, due to multiple associated complications. Considerable morbidity was seen in 52% of cases, including thromboembolic events (41%), catheter-related bacteremia (29%), fistulas (29%), and nephrotoxicity (25%). Six patients (25%) recurred after a median of 21 months of RFS. CONCLUSIONS: Cytoreductive surgery plus HIPEC in well-selected patients presenting with tumors that affect the peritoneum is a procedure that can be carried out in Colombia with an adequate safety and effectiveness profile. Mortality was similar to that reported in the international literature.
Asunto(s)
Antineoplásicos/uso terapéutico , Hipertermia Inducida , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Adulto , Terapia Combinada , Femenino , Hospitales de Enseñanza , Humanos , Tiempo de Internación , Masculino , Neoplasias Peritoneales/mortalidad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Se presenta el caso de un paciente con recesión gingival en un incisivo inferior, tratado con un injerto de tejido conectivo obtenido del paladar, la técnica utilizada para la toma se vale de una incisión única que permite una cicatrización por primera intención y mínimas molestias postoperatorias. El cubrimiento de la recesión en el presente caso clínico fue total (AU)
Asunto(s)
Humanos , Masculino , Adolescente , Recesión Gingival/cirugía , Tejido Conectivo , Colgajos Quirúrgicos , Índice Periodontal , Bolsa Periodontal/diagnóstico , Cepillado Dental/métodos , Raspado Dental/métodos , Encía/cirugíaRESUMEN
Se presenta el caso de un paciente con recesión gingival en un incisivo inferior, tratado con un injerto de tejido conectivo obtenido del paladar, la técnica utilizada para la toma se vale de una incisión única que permite una cicatrización por primera intención y mínimas molestias postoperatorias. El cubrimiento de la recesión en el presente caso clínico fue total