RESUMEN
Sister Mary Joseph's nodule (SMJN) is a rare umbilical nodule that develops secondary to metastatic cancer. Primary malignancies are located in the abdomen or pelvis. Patients with SMJN have a poor prognosis. An 83-year-old woman presented to our hospital with a 1-month history of a rapidly enlarging umbilical mass. Endoscopic findings revealed advanced transverse colon cancer. computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon, umbilicus, right inguinal lymph nodes, and left lung. The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels. Imaging findings of the left lung tumor allowed for identification of the primary lung cancer, and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made. The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection. Intra-abdominal dissemination to the mesocolon was confirmed during surgery. Histopathologically, the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma. We suspect that SMJN may occur via a hematogenous pathway. Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled, the patient and her family desired home hospice. Seven months after surgery, she died of rapidly growing lung cancer.
RESUMEN
BACKGROUND: There are few data on the efficacy of combination chemotherapy with a fluoropyrimidine plus cisplatin for patients with advanced or recurrent gastric cancer (AGC) complicated by peritoneal metastasis, especially massive ascites. METHODS: We retrospectively evaluated the efficacy and safety of a fluoropyrimidine (S-1 or capecitabine) plus cisplatin as first-line chemotherapy in 120 patients with AGC and peritoneal metastasis. RESULTS: Ascites was detected in 50 patients, with 11 patients having massive ascites. Median progression-free survival (PFS) and overall survival (OS) of all patients was 6.1 and 15.9 months, respectively. The PFS and OS were shorter in patients with massive ascites (n = 11; 3.7 and 9.5 months) compared with patients with small or moderate ascites (n = 39; 5.8 and 13.5 months) or patients without ascites (n = 70; 6.9 and 18.1 months). The objective response in terms of ascites was similar whether ascites was massive (4 of 11 patients; 36.4%) or small or moderate (16 of 39 patients; 41%). The frequencies of grade 3 or higher toxicity or treatment discontinuation due to toxicity are relatively similar across ascites groups. CONCLUSIONS: Fluoropyrimidine plus cisplatin appears to be tolerated in selected patients with peritoneal metastasis.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ascitis/patología , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Ascitis/etiología , Capecitabina , Cisplatino/administración & dosificación , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Supervivencia sin Enfermedad , Combinación de Medicamentos , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/análogos & derivados , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Ácido Oxónico/administración & dosificación , Neoplasias Peritoneales/secundario , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de Supervivencia , Tegafur/administración & dosificación , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Although there appears to be incomplete cross-resistance between docetaxel and paclitaxel in several types of malignancies, to our best knowledge there have been no available data on this for advanced gastric cancer. METHODS: We retrospectively evaluated the efficacy and safety of docetaxel in patients with paclitaxel-resistant advanced gastric cancer. Docetaxel was administered at 50-60 mg/m2 every 3 weeks. RESULTS: Twenty-one patients were evaluated. All patients had received 2 or more previous chemotherapy regimens. Among the 12 patients with measurable lesions, apparent tumor shrinkage was seen in 1 patient for an overall response rate of 8. 3% and a disease control rate of 33. 3%. Median progression free survival and overall survival of all patients were 2. 6 months and 6. 7 months, respectively. There were no correlations between the progression free survival of docetaxel and the progression free survival of previous paclitaxel and between the progression free survival of docetaxel and taxane-free interval(Spearman's correlation coefficients of ρ=-0. 14 and ρ=-0. 02, respectively). Grade 3/4 neutropenia developed in 8 patients(38%)and Grade 3 febrile neutropenia in 1 patient(4. 8%). CONCLUSIONS: Docetaxel showed modest activity in paclitaxel-resistant advanced gastric cancer patients, and no correlations between previous efficacy of paclitaxel or taxane-free interval were seen.
Asunto(s)
Antineoplásicos/uso terapéutico , Resistencia a Antineoplásicos , Neoplasias Gástricas/tratamiento farmacológico , Taxoides/uso terapéutico , Adulto , Anciano , Antineoplásicos/efectos adversos , Docetaxel , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Paclitaxel/uso terapéutico , Estudios Retrospectivos , Neoplasias Gástricas/patología , Taxoides/efectos adversosRESUMEN
A 41-year-old man was admitted to our hospital because of multiple liver tumors. Colonoscopy showed a mass lesion in the cecum. He was given a diagnosis of endocrine cell carcinoma by immunostaining technique, and received chemotherapy of CAPOX regimen for 3 courses. After that, he underwent second-line chemotherapy of EP(CDDP/VP-16)regimen due to deterioration of his performance status(PS), and his tumor marker NSE. He then showed dramatically improved PS, and improvement in the size of liver mets and NSE(4. 3mg/mL).
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciego/patología , Neoplasias del Colon/tratamiento farmacológico , Neoplasias de las Glándulas Endocrinas/tratamiento farmacológico , Adulto , Biopsia , Cisplatino/uso terapéutico , Neoplasias del Colon/patología , Neoplasias de las Glándulas Endocrinas/patología , Etopósido/uso terapéutico , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The new 7th edition of the American Joint Committee on Cancer TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. There is no information available on evaluation of the new staging system with regard to prognosis of patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal cancer patients treated with CRT. METHODS AND MATERIALS: A retrospective review was performed on 301 consecutive esophageal squamous cell carcinoma patients treated with CRT. Comparisons were made of the prognostic impacts of the 6th and 7th staging systems and the prognostic impacts of stage and prognostic groups, which were newly defined in the 7th edition. RESULTS: There were significant differences between Stages I and III (p < 0.01) according to both editions. However, the 7th edition poorly distinguishes the prognoses of Stages III and IV (p = 0.36 by multivariate analysis) in comparison to the 6th edition (p = 0.08 by multivariate analysis), although these differences were not significant. For all patients, T, M, and gender were independent prognostic factors by multivariate analysis (p < 0.05). For the Stage I and II prognostic groups, survival curves showed a stepwise decrease with increase in stage, except for Stage IIA. However, there were no significant differences seen between each prognostic stage. CONCLUSIONS: Our study indicates there are several problems with the 7th TNM staging system regarding prognostic factors in patients undergoing CRT.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/métodos , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Estadificación de Neoplasias/normas , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/mortalidad , Cisplatino/administración & dosificación , Neoplasias Esofágicas/mortalidad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias/métodos , Compuestos Organoplatinos/administración & dosificación , Pronóstico , Dosificación Radioterapéutica , Estudios Retrospectivos , Factores Sexuales , Tasa de Supervivencia , Carga Tumoral , Estados UnidosRESUMEN
OBJECTIVE: To retrospectively compare docetaxel (DTX) with paclitaxel (PTX) with regard to efficacy and safety in advanced or recurrent esophageal cancer patients who previously received platinum-based chemotherapy. METHODS: We retrospectively analyzed 124 advanced or recurrent esophageal cancer patients who had received platinum-based chemotherapy and then received DTX or PTX from April 2006 to November 2010. RESULTS: Eighty-six patients (69.4%) received DTX and 38 patients (30.6%) received PTX monotherapy. Due to toxicity, dose reduction was needed in 36.0 and 27.8% of patients and treatment was discontinued in 10.5 and 2.6% of patients receiving DTX and PTX, respectively. The objective response (25.7 vs. 10.3%, p = 0.03) and disease control rates (60.0 vs. 34.6%, p = 0.01) were higher in the PTX group than in the DTX group, respectively. There were no significant differences in median progression-free survival (2.1 vs. 3.5 months) and overall survival (6.1 vs. 7.2 months) between the DTX and PTX groups, respectively. Grade 3-4 neutropenia (48.8 vs. 21.1%, p = 0.003) and febrile neutropenia (20.9 vs. 5.3%, p = 0.029) were more frequent in the DTX patients than in the PTX patients, respectively. CONCLUSION: Although the efficacy of DTX and PTX for advanced or recurrent esophageal cancer patients after platinum-based chemotherapy was not significantly different in terms of survival, PTX was a more feasible treatment. PTX provided similar efficacy to DTX with less febrile neutropenia.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Esofágicas/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Paclitaxel/uso terapéutico , Taxoides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos Fitogénicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Docetaxel , Neoplasias Esofágicas/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Estudios Retrospectivos , Taxoides/efectos adversosRESUMEN
BACKGROUND: This study aimed to evaluate the efficacy of docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy for locally advanced borderline-resectable T4 esophageal cancer. PATIENTS AND METHODS: We retrospectively analyzed data regarding thirty patients with borderline-resectable T4 tumor who received either DCF or cisplatin plus 5-fluorouracil (FP) as induction chemotherapy. RESULTS: The overall response rate was significantly better for the DCF group than the FP group. In the DCF group, 6/16 patients achieved a grade 2 histological post-chemotherapeutic effect after treatment, compared to 1/14 in FP group. Except for myelotoxicity, no other significant differences in toxicity were observed during induction chemotherapy between groups. The DCF regimen did not result in increased postoperative complications compared to the FP regimen. Postoperative recurrence or distant metastasis was observed in 7/10 of FP patients and 5/12 of DCF patients. CONCLUSION: DCF induction chemotherapy may be an option for conversion therapy of initially unresectable, locally advanced esophageal cancer.
Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/cirugía , Fluorouracilo/uso terapéutico , Taxoides/uso terapéutico , Anciano , Antineoplásicos/efectos adversos , Cisplatino/efectos adversos , Supervivencia sin Enfermedad , Docetaxel , Femenino , Fluorouracilo/efectos adversos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/etiología , Recurrencia , Estudios Retrospectivos , Taxoides/efectos adversos , Resultado del TratamientoRESUMEN
The prognosis of patients with advanced colorectal cancer with icterus is dismally poor, and adequate chemotherapy for these patients has not been established yet. A 59-year-old male with fatigue, anorexia and icterus with serum total bilirubin 9.7 mg/dL was referred to our institution. He was diagnosed with advanced sigmoid colon cancer with multiple liver metastases. A biopsy specimen of the primary tumor showed well-differentiated adenocarcinoma without KRAS mutation. Since biliary drainage was impossible due to diffuse liver metastases, we initiated combination chemotherapy with 5-fluorouracil, Leucovorin, oxaliplatin (modified FOLFOX6) and cetuximab. The doses of 5-fluorouracil and oxaliplatin were reduced, but cetuximab was administered at the standard dosage. After 3 courses of chemotherapy, total bilirubin dropped to 0.8 mg/dL. No significant toxicity other than grade-2 skin toxicity and neuropathy was observed, and the patient has continued chemotherapy on an outpatient basis. Combination chemotherapy with mFOLFOX6 plus cetuximab was effective and feasible in this case of metastatic colon cancer with icterus due to diffuse liver metastasis.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Ictericia/etiología , Neoplasias Hepáticas/tratamiento farmacológico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia , Cetuximab , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/patología , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Disseminated intravascular coagulation (DIC) is a complication that may be experienced by patients with solid tumors. The prognosis of solid tumors with DIC is much poorer than those without DIC. Although treatment of the underlying disease is critical for improvement of DIC, the efficacy and safety of chemotherapy in patients with DIC associated with colorectal cancer are not clear. A 50-year-old man with advanced rectal cancer and multiple liver metastases experienced DIC during third-line treatment with cetuximab plus irinotecan, following 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX) plus bevacizumab and 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab. Combination chemotherapy consisting of FOLFOX plus bevacizumab was reintroduced. Although platelet and fresh-frozen plasma transfusions were required daily before chemotherapy, the patient's laboratory values improved after two cycles of chemotherapy, without severe toxicity. The patient was discharged, and FOLFOX plus bevacizumab has been continued on an outpatient basis without sign of recurrence of DIC as of December 2010 (4 months after initiation of chemotherapy). This case suggests that reintroduction of combination chemotherapy with FOLFOX plus bevacizumab is effective and feasible in patients with colorectal cancer with DIC and that chemotherapy may be a treatment option for such patients.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/patología , Bevacizumab , Coagulación Intravascular Diseminada/etiología , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Compuestos Organoplatinos/uso terapéutico , Neoplasias del Recto/complicacionesRESUMEN
BACKGROUND: The efficacy and safety of cetuximab for irinotecan-intolerant patients has not yet been evaluated in detail. METHODS: We retrospectively analyzed the efficacy and safety of cetuximab monotherapy for patients with metastatic colorectal cancer (MCRC) that was intolerant to irinotecan. RESULTS: Among 105 patients who received cetuximab-containing chemotherapy until March 2010, 22 patients were treated with cetuximab monotherapy due to irinotecan intolerance. Cetuximab was given at the approved dosage to all patients. The performance status was 2 or 3 in 17 patients (77%). All but 1 patient had wild-type KRAS tumors. The causes of irinotecan intolerance were icterus (n = 9; 41%; median serum total bilirubin, 6.3 mg/dl), symptomatic peritoneal metastasis or obstruction (n = 8; 36%), and thrombocytopenia (n = 1; 5%). Four patients (18%) refused irinotecan due to previous irinotecan-associated toxicity. Two patients achieved a partial response with an apparent drop of serum bilirubin, for a response rate of 9.1%. The median progression-free survival and overall survival were 1.6 and 3.5 months, respectively. No grade 3 or 4 adverse events or treatment-related deaths were experienced. CONCLUSION: Cetuximab monotherapy for irinotecan-intolerant MCRC is feasible. However, the overall efficacy was modest in the present cohort, despite the fact that most of the patients had wild-type KRAS tumors; further effective therapies should be evaluated to improve the prognosis of this patient population.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Antineoplásicos/efectos adversos , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Cetuximab , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Irinotecán , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
Malignant epithelioid variant of angiomyolipoma has aggressive characteristics, against which conventional cytotoxic agents have been reported to be disappointingly inactive, and the prognosis of unresectable or recurrent disease is dismal poor. A 52-year-old man with a history of left nephrectomy for epithelioid angiomyolipoma was referred to our institution. The computed tomographic scan showed a soft tissue dense mass around the Rex's recess and behind the spleen, and a large pelvic mass. Specimens obtained by percutaneous needle biopsy confirmed the recurrence of malignant epithelioid angiomyolipoma. Everolimus was initiated at 10 mg per day for recurrent disease. Computed tomographic scans 2 months later showed the tumors to be markedly decreased in size. The patient has continued with this treatment on an outpatient basis without signs of disease progression over 7 months, as of February 2011. In this case, treatment with everolimus resulted in dramatic tumor response for the malignant epithelioid variant of angiomyolipoma.
Asunto(s)
Angiomiolipoma/diagnóstico , Angiomiolipoma/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Células Epitelioides/patología , Neoplasias Renales/cirugía , Sirolimus/análogos & derivados , Serina-Treonina Quinasas TOR/antagonistas & inhibidores , Administración Oral , Angiomiolipoma/patología , Antineoplásicos/administración & dosificación , Antineoplásicos/farmacología , Everolimus , Humanos , Inmunosupresores/uso terapéutico , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Nefrectomía , Tomografía de Emisión de Positrones , Recurrencia , Sirolimus/administración & dosificación , Sirolimus/farmacología , Sirolimus/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
A 57-year-old female with advanced gastric cancer was referred to our hospital. She underwent neoadjuvant chemotherapy with S-1 plus cisplatin followed by curative gastrectomy. Weekly paclitaxel and combination chemotherapy with irinotecan plus cisplatin were administered for lymph node recurrence, but the tumor progressed. Since the human epidermal growth factor receptor 2 status of her gastric cancer specimen was strongly positive, docetaxel plus trastuzumab was administered for three cycles. However, the lymph node metastasis appeared to enlarge and abdominal pain worsened. Therefore, combination chemotherapy with lapatinib and weekly trastuzumab was initiated. A computed tomographic scan after 3 months of treatment showed stable disease. Although dose reduction of lapatinib was necessary due to Grade 3 diarrhea, the patient has continued this treatment on an outpatient basis without signs of disease progression for 8 months after initiation. In this case, trastuzumab plus lapatinib resulted in durable stable disease, despite the appearance of progression during prior chemotherapy with trastuzumab.
Asunto(s)
Adenocarcinoma Papilar/tratamiento farmacológico , Anticuerpos Monoclonales/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quinazolinas/administración & dosificación , Neoplasias Gástricas/tratamiento farmacológico , Dolor Abdominal/etiología , Adenocarcinoma Papilar/química , Adenocarcinoma Papilar/complicaciones , Adenocarcinoma Papilar/diagnóstico por imagen , Adenocarcinoma Papilar/patología , Anticuerpos Monoclonales Humanizados , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Quimioterapia Adyuvante , Progresión de la Enfermedad , Femenino , Humanos , Inmunohistoquímica , Lapatinib , Metástasis Linfática , Persona de Mediana Edad , Inhibidores de Proteínas Quinasas/administración & dosificación , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Receptor ErbB-2/análisis , Neoplasias Gástricas/química , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos X , Trastuzumab , Resultado del TratamientoRESUMEN
BACKGROUND: Although fluoropyrimidines, platinum agents, taxanes, and irinotecan are used in the treatment of advanced gastric cancer (AGC), it remains unclear whether these agents in any line of chemotherapy are associated with overall survival (OS) in these patients. METHODS: We retrospectively analyzed 704 patients with AGC. To avoid possible lead-time bias, we applied time-varying covariate analysis for chemotherapy with four agents in any line. RESULTS: Median OS was 12.3 months. The frequency of exposure to each agent class during all lines of treatment was 92.6% for FU (5-fluorouracil or oral fluoropyrimidine), 48.2% for platinum agents, 65.1% for taxanes, and 39.1% for irinotecan. According to a multivariate Cox model with exposure to each agent class as a time-varying covariate, the hazard ratios (HRs) of death were 0.41 (95% confidence interval [CI], 0.27-0.57; p < 0.001) for FU, 0.71 (95% CI, 0.58-0.84; p < 0.001) for platinum agents, 0.51 (95% CI, 0.41-0.63; p < 0.001) for taxanes, and 0.53 (95% CI, 0.43-0.65; p < 0.001) for irinotecan. Although other agents were used in 18.6% of the patients, they did not affect survival. CONCLUSIONS: Each of the four agent classes (FU, platinum agents, taxanes, and irinotecan) appears to be independently associated with improved OS in patients with AGC regardless of timing. This result suggests the importance of developing strategies which make these active agents available to all patients with AGC to prolong OS.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/mortalidad , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Estudios de Cohortes , Femenino , Fluorouracilo/uso terapéutico , Humanos , Irinotecán , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Compuestos de Platino/uso terapéutico , Estudios Retrospectivos , Taxoides/uso terapéuticoAsunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Neoplasias Encefálicas/patología , Disnea/diagnóstico , Hemangioendotelioma Epitelioide/tratamiento farmacológico , Neoplasias Pulmonares/diagnóstico , Anticuerpos Monoclonales Humanizados , Bevacizumab , Neoplasias Encefálicas/complicaciones , Disnea/etiología , Femenino , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/etiología , Humanos , Neoplasias Pulmonares/etiología , Metástasis Linfática , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: We performed a systematic review and meta-analysis to determine the impact of neutropenia or leukopenia experienced during chemotherapy on survival. METHODS: Eligible studies included prospective or retrospective analyses that evaluated neutropenia or leukopenia as a prognostic factor for overall survival or disease-free survival. Statistical analyses were conducted to calculate a summary hazard ratio and 95% confidence interval (CI) using random-effects or fixed-effects models based on the heterogeneity of the included studies. RESULTS: Thirteen trials were selected for the meta-analysis, with a total of 9,528 patients. The hazard ratio of death was 0.69 (95% CI, 0.64-0.75) for patients with higher-grade neutropenia or leukopenia compared to patients with lower-grade or lack of cytopenia. Our analysis was also stratified by statistical method (any statistical method to decrease lead-time bias; time-varying analysis or landmark analysis), but no differences were observed. CONCLUSIONS: Our results indicate that neutropenia or leukopenia experienced during chemotherapy is associated with improved survival in patients with advanced cancer or hematological malignancies undergoing chemotherapy. Future prospective analyses designed to investigate the potential impact of chemotherapy dose adjustment coupled with monitoring of neutropenia or leukopenia on survival are warranted.
Asunto(s)
Antineoplásicos/uso terapéutico , Leucopenia/inducido químicamente , Neoplasias/sangre , Neoplasias/tratamiento farmacológico , Neutropenia/inducido químicamente , Antineoplásicos/efectos adversos , Humanos , Neoplasias/diagnóstico , Pronóstico , Análisis de SupervivenciaRESUMEN
Weekly paclitaxel is an effective and widely used regimen for patients with advanced gastric cancer, with main dose-limiting toxicities of neutropenia and neurotoxicity. Neutropenia during weekly paclitaxel administration was reported to be associated with better survival. The aim of this study is to evaluate prospectively whether dosing adjustments based on the occurrence of neutropenia may improve chemotherapy efficacy. A total of 90 patients will be randomized to receive either a standard dose of weekly paclitaxel (80 mg/m(2)) or an escalated dose of weekly paclitaxel (80 mg/m(2) initially followed by 100 and 120 mg/m(2) unless severe toxicity is observed). The primary endpoint is overall survival. Secondary endpoints include progression-free survival, response rate, disease control rate and adverse events.