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Perevezentsev, Egor Aleksandrovich, Anastasiya Sergeevna Malykhina, Mark Albertovich Volodin, Denis Igorevich Volodin, and Evgeniy Nikolaevich Bolgov. "Risk factors, morbidity rates and long-term prognosis in benign hyperplasia and prostate cancer (literature review)." Spravočnik vrača obŝej praktiki (Journal of Family Medicine), no. 6 (June 1, 2021): 24–33. http://dx.doi.org/10.33920/med-10-2106-03.
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Diseases of the urological profile are one of the most important medical and social issues of the modern world. According to various sources, from 50 % to 75 % of men over 50 years old have benign prostatic hyperplasia (BPH), and by the age of 80, BPH is detected in 90 % of the male population. BPH manifests itself with lower urinary tract symptoms (LUTS) in most patients. Prostate cancer ranks 2nd or 3rd in the structure of malignant neoplasms in men, and the prevalence of this pathology continues to grow. This trend is associated with an increase in average life expectancy, improved diagnosis of pathologies and early detection of the disease. Risk factors affecting the development of both prostate cancer and BPH include the patient’s age, race, family history, eating habits, the presence or absence of bad habits, and a sedentary lifestyle. Surgical methods for treating prostate cancer include open retropubic prostatectomy and laparoscopic adenomectomy. The «gold standard» of surgical treatment of BPH is transurethral resection of the prostate (TURP), but the emergence of new endovideosurgical methods (bipolar TURP, transurethral enucleation of the prostate (TUEP) allows to expand the scope of their use and reduce possible complications in the early and late postoperative period.
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Fabiani, Andrea, Emanuele Principi, Alessandra Filosa, and Lucilla Servi. "The eternal enigma in prostatic biopsy access route." Archivio Italiano di Urologia e Andrologia 89, no. 3 (October 3, 2017): 245. http://dx.doi.org/10.4081/aiua.2017.3.245.
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Dear Editors,We read with interest the article by Di Franco and co-workers (1). The introduction of prostatic magnetic resonance and the relative fusion-biopsy have not yet allowed the expected improvements in prostate biopsy. To our knowledge, there are no works that demonstrate the superiority of fusion techniques on the remaining ultrasound guided prostate biopsies that are still the widely used in the diagnosis of prostate cancer. Furthemore, these technologies are expensive exams and they are not yet available in all centers, especially in those minors. We work at a “minor” center and we always keep in mind that the goal of prostatic biopsy is the diagnosis and the staging of prostatic neoplasms.. However, it remains uncertain which of the two techniques, transperineal (TP) or transrectal (TR), is superior in terms of detection rate during first biopsy setting. Several studies have compared the prostate cancer detection rate but TR and TP access route in prostatic gland sampling seems to be equivalent in terms of efficiency and complications, as reported by Shen PF et al. (2), despite several methodological limitations recognized in their work. The results reported by Di Franco CA et al. represent the real life experience of most urologists that perform the PB based on their own training experience and available technical devices. From an historical viewpoint, the TP route has been the first one to be used to reach the prostate, both for diagnostic and therapeutic purposes. To date, because it seems to be more invasive and difficult, the TP route is less used worldwide than the TR one (2). Theoretically, the TP approach should detect more prostate cancer than the TR way because the cores of the TP approach are directed longitudinally to the peripheral zone and the anterior part of the prostate (4). The results reported by Di Franco et al. seems to confirm these considerations. However, our real life experience differ from the conclusions reached in their work. We recently conducted a prospective evaluation of 352 patients who underwent their first prostate biopsy because of a suspicious of prostate cancer (elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination and/or abnormal findings on transrectal prostatic ultrasound). Patients was randomized as following. A total of 187 patients (Group A) underwent a prostatic biopsy with a transperineal approach in a lithotomic position, using a biplane probe (8818 BK Medical, Denmark) and a fan technique with a single perineal median access (5). The remnants 165 patients (Group B) underwent a transrectal ultrasound guided prostate biopsy in a left lateral position, using a end fire probe configuration (8818 BK Medical, Denmark) and a sagittal technique. The bioptic prostatic mapping was performed with a 12-core scheme sec. Gore (3) by a single experienced operator and the histopathologic evaluation was performed by a single dedicated uro-pathologist. Statistical evaluations were made with a T Student test (p<0,005). Group A and Group B was similar in term of mean patient age (67,9 years and 67 years respectively), mean total PSA (12,1 ng/ml vs 12 ng/ml) and digital rectal examination positivity (22% vs 29%). The global cancer detection rate was 33,69% (63/187) in the transperineal prostate biopsy group and 48,48 % (80/165) in the transrectal approach (p=0.0047). No significant statistical differences were found in the complications rates between the two groups. Statistical evaluation of site of tumor localization reveal only a trend to statistical significance in apical site tumors diagnosed with the TR approach versus the TP technique. The TR approach had a better diagnostic accuracy than TP technique in case of PSA<4 ng/ml, intermediate prostate volume (30 and 50 ml), normal digital rectal examination without any relationship with the patient age. In our experience, two aspect may explain the difference between the two group in term of global detection rate. First, we usually perform transrectal biopsy with a sagittal technique that simulates the transperineal way of needle incidence with the prostatic gland. The lateral and anterior gland portions may be sampled more accurately. Second, our transperineal approach consists in a single perineal median access that can make more difficult the gland sampling between the two lobes. However, there was no significant difference in core positivity rate at the peripheral zone, medium gland, apex or any other site such as reported in many randomized clinical trials (2). Unlike the conclusions reported by Di Franco et al., in our experience we found a statistically significant difference between the TR and TP approach, at the first biopsy setting, in term of global cancer detection rate. No differences were found in terms of complications. Moreover, our data suggest that TR approach had a better diagnostic accuracy than TP technique in case of PSA<4 ng/ml, prostate volume 30-50 ml, normal digital rectal examination without any relationship with the patient age. The further step of the statistical evaluation of our data will be the definition of the possibility that the TR biopsy determine a better staging of prostate cancer than TP approach as first procedure. REFERENCES 1) Di Franco CA, Jallous H., Porru D. et al. A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer Arch Ital Urol Androl 2017; 89(1), 55-92) Shen FP, Zhu YC, Wei WR et al. The results of transperineal vs transrectal prostate biopsy: a systematic review and meta-analysis. Asian Journal of Androl 2012; 14: 310-15.3) Gore JL., Shariat SF, Miles BJ., et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 2001; 165: 1554-59. 4) Abdollah F., Novara G., Briganti A. et al. Trasrectal versus transperineal saturation re biopsy of the prostate: is there a difference in cancer detection rate? Urology 2011; 77:9215) Novella G, Ficarra V, Galfano A, et al. Pain assessment after original transperineal prostate biopsy using a coaxial needle. Urology. 2003; 62 : 689-92.
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Krasnyak, S. S. "Pathogenetic therapy of benign prostatic hyperplasia and prostatic intraepithelial neoplasia." Experimental and Сlinical Urology 13, no. 4 (October 30, 2020): 66–74. http://dx.doi.org/10.29188/2222-8543-2020-13-4-66-74.
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Introduction. Benign prostatic hyperplasia (BPH) is a neoplasm and clinically occurred by progressive enlargement of the prostate. However, prostate neoplasm can also be malignant, which is come out from high-grade prostatic intraepithelial neoplasia (PIN). It is a proven precancerous condition. Purpose. Тo evaluate the data published on September and October 2020 on the prevalence, pathogenesis of BPH and PIN and methods of their treatment. Materials and methods. The search results in scientific databases PubMed, MEDLINE, Embase were analyzed for the queries «BPH», «PIN», «epidemiology of BPH», «pathogenesis», «treatment of PIN». Results. BPH is a very common disease in the elderly population. The pathogenesis of BPH includes age, genetics or hormones disorders, growth factors, inflammation, and lifestyle factors. PIN is the only common precursor of prostatic cancer. The main treatment methods are 5α-reductase inhibitors, phosphodiesterase-5 inhibitors, and surgical methods. In addition, plant active molecules are also widely used in the treatment of BPH and PIN. Conclusions. While 5α-reductase and phosphodiesterase-5 inhibitors treatment, as well as surgical methods have a lot of adverse events and complications, a unique herbal complex Gardaprost was developed, which suppresses hyperplasia of prostate. Curcumin, genistein and epigalocatechin-3- gallate, which are part of the preparation, form a safe agent aimed at combating the growth of the prostate gland in BPH, and also has a significant effect in the prevention of exacerbations of chronic prostatitis and malignancy in patients with PIN.
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Child, Christopher J., Daniel Conroy, Alan G. Zimmermann, Whitney W. Woodmansee, Eva Marie Erfurth, and Leslie L. Robison. "Incidence of primary cancers and intracranial tumour recurrences in GH-treated and untreated adult hypopituitary patients: analyses from the Hypopituitary Control and Complications Study." European Journal of Endocrinology 172, no. 6 (June 2015): 779–90. http://dx.doi.org/10.1530/eje-14-1123.
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ObjectiveSpeculation remains that GH treatment is associated with increased neoplasia risk. Studies in GH-treated childhood cancer survivors suggested higher rates of second neoplasms, while cancer risk data for GH-treated and untreated hypopituitary adults have been variable. We present primary cancer risk data from the Hypopituitary Control and Complications Study (HypoCCS) with a focus on specific cancers, and assessment of recurrence rates for pituitary adenomas (PA) and craniopharyngiomas (CP).DesignIncident neoplasms during HypoCCS were evaluated in 8418 GH-treated vs 1268 untreated patients for primary malignancies, 3668 GH-treated vs 720 untreated patients with PA history, and 956 GH-treated vs 102 untreated patients with CP history.MethodsUsing population cancer rates, standardised incidence ratios (SIRs) were calculated for all primary cancers, breast, prostate, and colorectal cancers. Neoplasm rates in GH-treated vs untreated patients were analysed after propensity score adjustment of baseline treatment group imbalances.ResultsDuring mean follow-up of 4.8 years, 225 primary cancers were identified in GH-treated patients, with SIR of 0.82 (95% CI 0.71–0.93). SIRs (95% CI) for GH-treated patients were 0.59 (0.36–0.90) for breast, 0.80 (0.57–1.10) for prostate, and 0.62 (0.38–0.96) for colorectal cancers. Cancer risk was not statistically different between GH-treated and untreated patients (relative risk (RR)=1.00 (95% CI 0.70–1.41), P=0.98). Adjusted RR for recurrence was 0.91 (0.68–1.22), P=0.53 for PA and 1.32 (0.53–3.31), P=0.55 for CP.ConclusionsThere was no increased risk for all-site cancers: breast, prostate or colorectal primary cancers in GH-treated patients during HypoCCS. GH treatment did not increase the risk of PA and CP recurrences.
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Metrogos, Vanessa, Nuno Ramos, Celso Marialva, and João Bastos. "Rare Association between Prostate Adenocarcinoma and Schistosomiasis: A Case Report." Acta Urológica Portuguesa 34, no. 3-4 (December 17, 2017): 42–43. http://dx.doi.org/10.24915/aup.34.3-4.45.
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Human schistosomiasis, the second most devastating parasitic disease, is common in developing countries, but rare in Europe. Urogenital tract involvement is mainly due to Schistosoma haematobium infection. Schistosomiasis has long been associated with malignant neoplasia. Some authors have hypothesized a causal relationship between schistosomiasis and carcinoma of the bowel, kidney, bladder and prostate. To data only 17 cases of concomitant prostatic adenocarcinoma and gland schistosomiasis have been described. As an uncommon example of a potential complication of an untreated schistosomiasis, we report a case of an incidentally diagnosed urinary schistosomiasis after a radical prostatectomy for prostate adenocarcinoma in a 62-year-old African man living in a non-endemic area.
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Jacobs, Terry M., Bruce R. Hoppe, Cathy E. Poehlmann, Marie E. Pinkerton, and Milan Milovancev. "Metastasis of a Prostatic Carcinoma along an Omental Graft in a Dog." Case Reports in Veterinary Medicine 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/141094.
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An 11-year-old male American Bulldog was presented for hematuria and tenesmus. It had been treated for chronic bacterial prostatitis with abscessation two years earlier and underwent castration and a prostatic omentalization procedure. There was no histologic evidence of prostatic neoplasia at that time. On physical examination, an enlarged prostate was found by rectal palpation, and it was characterized with ultrasonography and computed tomography. Surgical biopsies were obtained, and histopathology identified prostatic adenocarcinoma. It received carprofen and mitoxantrone chemotherapy in addition to palliative radiation therapy; it was euthanized six weeks later due to a progression of clinical signs. Necropsy findings included marked localized expansion of the prostatic tumor and dissemination of prostatic carcinoma cells throughout the peritoneal cavity along the omental graft with infiltration onto the serosal surfaces of most abdominal viscera and fat. This case represents a previously unreported potential complication of the omentalization procedure wherein carcinoma cells from a prostatic tumor that independently arose after omentalization may have metastasized along the surgically created omental graft.
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Dalal, S., and D. Jhala. "Utility Of Ebus-Tbna In Diagnosis And Staging Of Lung Nodules In The Setting Of Known Second Malignancy In Veterans - A Quality Assurance Study." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S162—S163. http://dx.doi.org/10.1093/ajcp/aqaa161.354.
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Abstract Introduction/Objective Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is minimally invasive procedure for diagnosis/staging/restaging of lung nodules, recommended by the National Comprehensive Cancer Network (NCCN) 2017 Clinical Practice Guidelines. Veteran patients are an elderly patient cohort with multiple comorbidities and many have existing known 2nd malignancy. It will be crucial to diagnose and appropriately stage lung nodules. Our primary aim was to assess the efficacy of EBUS-TBNA in diagnosis/nodal staging in elderly patients with known 2nd malignancy. Our secondary aim was to evaluate the safety of this procedure for veterans. Methods A retrospective search for cases of EBUS-TBNA in patients with known second malignancy was carried out in Vista/Fileman at the Corporal Michael J Crescenz VA Medical Center between the period of June 2019 to January 2020. Sites included lung, cervical lymph nodes, mediastinum and hilar region. Results Of total 93 EBUS-TBNA procedures performed; EBUS-TBNA targeted both the lung and lymph node (62 cases), lymph nodes alone (28 cases) and only lung (3 cases). Total 53 were diagnosed malignant; with primary being lung (39 cases) and pleura (2 cases); and diagnosis of new metastatic carcinomas to lung was made in (12 cases). The metastatic neoplasms included 2 urothelial carcinoma, 7 squamous carcinoma, 2 metastatic adenocarcinoma, and 1 prostatic adenocarcinoma. 32/53 (60.3%) had the history of prior extrapulmonary second malignancy. Immunohistochemical studies was able to be performed in 50/53 (94%) of malignant cases, predictive marker PD-L1 on 50/53 (94%) cases, molecular testing on 23/53(43.3%) cases and Foundation One testing (Cambridge, MA, NGS) on 11/53(20.7%) cases. In all 93 cases, there were no complications (0/93) (0%) of the procedure. Conclusion EBUS-TBNA is an efficient, cost effective and minimally invasive modality in elderly veteran patient population with multiple co-morbidities. EBUS-TBNA is successful in procuring adequate material for diagnosis, molecular and predictive marker studies; thus, it can play a crucial role in precision oncology. EBUS-TBNA plays a pivotal role diagnosing and ruling out metastatic nodal disease in veteran patient population which has a high incidence of known 2nd extrapulmonary malignancy. EBUS-TBNA is deemed safe in veterans.
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Gevorkyan, Ashot, Ilya Lumpov, and Armen Avakyan. "THE INFLUENCE OF TRANSRECTAL MULTIFOCAL PROSTATE BIOPSY UNDER ULTRASOUND CONTROL ON THE DEGREE OF INFRAVESICAL OBSTRUCTION IN DIFFERENT GROUPS OF PATIENTS." EUREKA: Health Sciences 5 (September 30, 2016): 13–16. http://dx.doi.org/10.21303/2504-5679.2016.00184.
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Prostate cancer - is a malignant neoplasm arising from prostatic epithelium. [1] It is well known, that prostate cancer is the most common cancer in men population. Most patients, who underwent a biopsy of prostate, have expressed varying degrees of benign prostatic hyperplasia and, accordingly, symptoms, specific to the disease, including symptoms of the lower urinary (LUTS). [2], Uroflowmetry is a method widely used around the world to assess the degree of severity of infravesical obstruction [3]. The aim was to determine the degree of influence of transrectal multifocal biopsy of the prostate under ultrasound control on the degree of infravesical obstruction [4]. The study included patients with elevated serum PSA over 4 ng/ml with the volume (Vpr) of prostate from 20 cm³ to 90 cm³, volume of residual urine no more than 50 cm ³. Uroflowmetry was performed with the determination of the volume of residual urine at the primary treatment. At 21 day after transrectal multifocal prostate biopsy under Ultrasound control all patients underwent uroflowmetry. The age of patients ranged from 40 to 70 years. Patients were divided into 3 groups depending on the volume of the prostate gland. The first group consisted of 28 people where prostate volume ranged from 20 cm³ to 40 cm³, in the second group, consisted of 25 persons, prostate volume ranged from 41 cm³ to 60 cm³, and in the third group, consisted of 30 people, prostate volume ranged from 61 cm³ to 90 cm³. The following indicators of urofloumetry were determined as the following: voided volume, max flow rate, average flow, voiding time, flow time, time to max flow, and the volume of residual urine. This study has demonstrated a high risk of complications in patients with prostate volume of more than 60 cm3 caused by infravesical obstruction after prostate biopsy.
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Minari, R., C. Cantoni, I. Pieri, P. Sacchini, A. Prati, A. Savino, and D. Potenzoni. "Mass screening for prostatic carcinoma and therapeutic options." Urologia Journal 59, no. 1_suppl (January 1992): 301–3. http://dx.doi.org/10.1177/039156039205901s98.
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In western countries, prostatic carcinoma is the most frequent neoplasia in the male sex after pulmonary neoplasia. Its early diagnosis is very important. The authors report the results of a screening for prostatic carcinoma effected in some municipalities of the district of Parma (Italy); 28 prostatic carcinomas were diagnosed (1.2% of the examined patients). Twelve patients were submitted to radical nerve-sparing prostatectomy according to Walsh. In all of them, PSA values decreased to values < 1 ngr/ml, confirming the radicality of the operation and few complications occurred. The conclusion of the authors is that nowadays timely radical prostatectomy is the only “definitive” treatment of prostatic carcinoma, allowing a better quality of life, however long it is.
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Pasov, V. V., V. A. Korotkov, M. R. Kasymov, L. V. Aferkina, N. Р. Naumov, and А. S. Brycheva. "Principles of treatment of late rectal radiation damage in cancer patients." Andrology and Genital Surgery 22, no. 1 (April 22, 2021): 21–27. http://dx.doi.org/10.17650/1726-9784-2021-22-1-21-27.
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Malignant neoplasms of the pelvic organs in the structure of cancer incidence make up about 30 % of the adult population of our country. The widespread use of radiation therapy, unfortunately, has also increased the frequency of radiation damage to the pelvic organs, which, as a rule, take a chronic course. Late radiation damage to the pelvic organs is a fairly common complication of radiation therapy for prostate cancer. According to various authors, the frequency of such iatrogenic pathological changes is up to 25 %. In fact, some patients who are cured of a malignant neoplasm acquire a new disease that significantly reduces the quality of life and requires treatment. During radiation therapy of prostate cancer, various anatomical formations can fall into the zone of radiation fields: the bladder, rectum, intra-pelvic tissue, neurovascular bundles and pelvic bones. It should be noted that isolated lesions of one organ are rare and in most cases they are combined. A special place in clinical practice is occupied by cases of local radiation injuries of the rectum, including severe complications of radiation and combined treatment associated with the formation of fistulas against the background of radiation-induced intra-pelvic fibrosis in the absence of a relapse of the underlying disease. In addition, this situation is associated with a violation of the psycho-emotional status of patients, a sharp decrease in the quality of life, difficulties in social adaptation in society and family, pain syndrome, and problems of medical rehabilitation. Unfortunately, conservative measures for such local radiation injuries are not always effective, and the results of surgical interventions are far from ambiguous and require careful study of patients, search for an algorithm of indications and acceptable standardization of surgical manipulations. This paper presents the basic principles of diagnosis, comprehensive treatment and rehabilitation of patients with late radiation rectitis, depending on the severity of the pathological process. Given the growth of malignant neoplasms of the pelvic organs, we can assume a relative increase in the number of patients with complications associated with radiation therapy, which require rehabilitation measures. Such patients come to the attention of oncologists, radiologists, coloproctologists, gastroenterologists and therapists, etc. Currently, our country lacks a network of specialized regional departments that deal with this problem, as well as treatment standards, clinical recommendations, and an algorithm for diagnostic and rehabilitation measures for local radiation injuries. In connection with the above, it became necessary to summarize the data of clinical studies based on their own experience.
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Nayyar, Dhruv, Kavitha Muthiah, Christopher S. Hayward, Zerlene Lim, Emily K. Granger, Mark Nicholls, and Allan R. Glanville. "Pulmonary Tumor Thrombotic Microangiopathy from Metastatic Prostate Carcinoma." Case Reports in Pulmonology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/286962.
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Pulmonary tumor thrombotic microangiopathy is a rare but serious malignancy-related respiratory complication. The most common causative neoplasm is gastric adenocarcinoma. We report a case caused by metastatic prostate adenocarcinoma, diagnosed postmortem in a 58-year-old male. To our knowledge, this is the second reported case from metastatic prostate adenocarcinoma.
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Guerra, Rosa, and Subhasis Misra. "Management of Extramammary Paget's Disease: A Case Report and Review of the Literature." Case Reports in Dermatological Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/436390.
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Extramammary Paget's Disease (EMPD) is a rare condition of the skin that often involves the vulva, perianal region, scrotum, penis, and axilla. Although prognosis is generally favorable, it can be associated with neoplasms of the bladder, urethra, prostate, and rectum. This report presents a case of scrotal EMPD that failed treatment with imiquimod 5% cream and discusses benefits and complications of available treatment options. The variation of treatment success emphasizes the importance of further research.
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Nolte, Dawn M., Carol A. Carberry, Kristi M. Gannon, and Frank C. Boren. "Temporary Tube Cystostomy as a Treatment for Urinary Obstruction Secondary to Adrenal Disease in Four Ferrets." Journal of the American Animal Hospital Association 38, no. 6 (November 1, 2002): 527–32. http://dx.doi.org/10.5326/0380527.
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Adrenal neoplasia is a common problem in middle-aged to older ferrets. Male ferrets may present for stranguria and dysuria due to prostatic/paraurethral tissue enlargement secondary to elevation in androgens produced by the neoplastic tissue. Progressive urethral compression followed by complete urinary obstruction can result. Urinary obstruction can persist for days following surgery requiring urinary diversion. Four ferrets presenting with signs consistent with urinary obstruction secondary to adrenal disease were immediately treated with urethral catheterization or cystocentesis followed by adrenalectomy and temporary tube cystostomy. The tube cystostomy placement and use were associated with minimal complications and allowed recovery from surgery.
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Santos-Filho, Sebastião David, Sotiris Missailids, Adenilson de Souza da Fonseca, and Mario Bernardo-Filho. "Prostate cancer, treatment modalities and complications: an evaluation of the scientific literature." Brazilian Archives of Biology and Technology 51, spe (December 2008): 51–56. http://dx.doi.org/10.1590/s1516-89132008000700009.
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Prostate (PR) cancer (CA) is one of the most common malignant neoplasms in men all over the world. In general, if prostate cancer (PC) is detected early, treatment usually involves either surgical removal of the prostate or radiotherapy (RT). Hormone Therapy (HT) or chemotherapy (CH) is the preferred treatment for more advanced cases of PC or if CA spreads beyond the PT. A number of complications, such as urinary incontinence (IU) or erectile dysfunction (ED), can be associated with some modalities of treatment of the PC. The aim of this work is to evaluate, in PubMed, the number of publications related with prostate cancer and the main modalities of treatment, as well as some clinical complications. The searches were performed in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) in the period 1950 to 2008 using the words: (i) CA, (ii) CA and PR or penis or testis, (iii) CA and PR and RT, CA and PR and surgery (SU), CA and PR and CH and, CA and PR and HT and (iv) CA and PR and RT and IU or ED, CA and PR and SU and IU or ED, CA and PR and CH and IU or ED and, CA and PR and HT and CH and IU or ED, and (V) PC and the same modalities of treatment. The data was obtained on July 20th, 2008. PC, as expected has been cited extensively and surgery has been identified as the most widely referenced modality of treatment. Furthermore, urinary incontinence and erectile dysfunction are important complications that have attracted significant scientific interest. In conclusion, these findings have shown the relevance of the PubMed to analyze quantitatively the publications in cancer and this information could be worthwhile in aiding the comprehension of some clinical aspects related with PC, as well as the development of preventative actions. The analysis of the scientific interest, considering the number of publications in the PubMed, reveals research trends in the field and demonstrates the importance of the surgical procedures in the treatment of the prostate cancer. Moreover, this finding is relevant due to the fact that surgery is the treatment of choice when early detection of PC is achieved. However, it is important to consider clinical complications related to such procedures, such as urinary incontinence and erectile dysfunctions that can reduce the quality of life of the patient.
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Syniachenko, O., Yu Dumanskiy, O. Stoliarova, M. Paliy, and M. Iermolaieva. "Tumor markers in the process of radiotherapy of patients with prostate cancer." Bukovinian Medical Herald 24, no. 4 (96) (November 26, 2020): 105–9. http://dx.doi.org/10.24061/2413-0737.xxiv.4.96.2020.110.
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Purpose of the work – to assess the level of tumor markers in the blood of patients with prostate cancer (PC) in the course of their radiation therapy (RT). Material and methods. The study included 195 men with prostate cancer aged 52 to 82 years. The duration from the moment of diagnosis of the disease was 3 years on average. The Gleason score parameters averaged 6 points, the ratio of peripheral to central tumor form was 3: 1, adenocarcinoma was diagnosed in 94% of the cases, and giant cell carcinoma – in 6%. The average tumor stage parameter was 3 relative units, maturity was 3 points. Blood levels of testosterone (TS), luteinizing hormone (LT), insulin-like growth factor 1 (ISF), alkaline phosphatase (AP), acid prostatic phosphatase (APP) and glycosyl hydrolase (GH) activities were evaluated.Results. An increase in the level of tumor markers is observed in 50% - 100% of the patients, which depends on the expansion, size, localization, stage and degree of differentiation of the tumor process, the nature of its metastasis to the lymph nodes, distant organs and skeleton. Radiation therapy in patients with prostate cancer has an effect on integral changes in tumor markers, in particular, on the restoration of blood PSA parameters and APP activity; moreover, in the group of examined patients with an early initiation of RT after prostatectomy, positive changes in the studied parameters are more significant, do not depend on the expansion, size, and the degree of maturity of the neoplasm, but the nature of the dynamics of the levels of PSA, APP and ISF is closely related to the initial indicator of the severity of the tumor process course.Conclusion. The study of the level of tumor markers in the blood will have clinical and prognostic significance for assessing the efficacy of treatment of a tumor process, and contribute to the development of criteria for diagnosing complications of radiation therapy.
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Andrade-Campos, Marcio, Abelardo Barez, Soledad Noya, M. Angeles Fernández-Galán, Jose Balanzat, F. García-Bragado, Angela Ibañez, and Pilar Giraldo. "Incidence of Malignancies in Gaucher's Disease Patients. Data of Spanish Gaucher's Disease Registry." Blood 128, no. 22 (December 2, 2016): 4881. http://dx.doi.org/10.1182/blood.v128.22.4881.4881.
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Abstract Introduction: Patients with type1 Gaucher's disease (GD1) have an increased risk of gammopathy (RR,33 Taddei TH 2009), multiple myeloma (RR,25.), other haematological malignancies (RR,3.45) and overall cancer risk (RR, 1.80). The Spanish Registry of Gaucher Disease (SpRGD) was established in 1993 in response to the need to group individual experiences in the diagnosis and management of this disease, increasing knowledge related to general characteristics and to know the real incidence and prevalence in the Spanish population. Registration is open to all physicians involved in the management of patients with GD and offers free enzymatic analysis, biomarkers and molecular analysis for the diagnosis and monitoring of patients (www.feeteg.org). Aim: to analyses the incidence of malignancies in adults GD patients. Patients and methods: A review of the SpRGD to obtain data form patients over 20 years of age at May, 2016 was performed. Physicians on charge fulfilled a survey in which they inform about the incidence of malignancies and follow-up information. Ethical approval was obtained from the institutional board and all patients has signed an inform consent before to be included into the SpRGD. Results: Of the 281 adult patients (³20 years) included, 279 were GD1 and 2 GD3. The average age of the entire cohort was 52.3 (23-90), of which 140 men, 141 women. Of these, 27 (9.6%) patients with GD1, 5 homozygous for N370S and 22 heterozygous for N370S had the presence of a malignancy and / or monoclonal gammopathy (MGUS), two of them had more than one neoplasia. Male / female: 11/16, mean age 60.2 (25-90), median follow-up of 16.5 years (4-23). Six have died by the tumor complications. All MGUS (N=12) were identified at GD diagnosis, they were 6 males and 6 females mean age 55.5 y (10-82) of them 50% under 60 years of age. Sixteen patients developed seventeen different neoplasms, with a female predominant (11, 68.7%). Only eight patients were under therapy at the time of neoplasia diagnosis (table1). Mean time on therapy 7.4 years (1.2-13-6). Neoplasms were registered (M/ F): B cell malignancies: Hodgkin lymphoma 1 (M), chronic lymphocytic leukemia 1 (M), multiple myeloma 1 (M), myeloid neoplasms: chronic myeloid leukemia: 1 (F), myelodysplastic syndrome: 1 (F), solid tumors: melanoma: 1 (F), meningioma: 2 (F), uterine cancer: 3 (F), gastric carcinoma 1 (F), cancer colon 2 (F), breast cancer 1 (F), prostate adenocarcinoma: 1(M), lung cancer 1 (M), liver carcinoma 1 (M), thyroid cancer 1 (F). Conclusions: It has been widely reported the highest incidence of haematological malignancies among patients with GD. Nevertheless in this cohort of Spanish patients, the incidence of solid tumors is similar to haematological neoplasms in general and higher than B cell lymphoid. Probably the incidence of malignancy in this population and during this monitoring period is similar to the expected in Spanish general population found in 0.21% / year, however females showed two times risk increase for malignancies and this aspect warranty further studies. This work has been carried out with aid for research FIS PS15/00616 and FEETEG Disclosures No relevant conflicts of interest to declare.
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Ulys, Albertas, Alvydas Vėželis, Marius Snicorius, and Marius Anglickis. "The first clinical experience in prostate cancer salvage cryotherapy." Acta medica Lituanica 20, no. 4 (February 7, 2014): 199–205. http://dx.doi.org/10.6001/actamedica.v20i4.2817.
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Introduction. Prostate cancer is the most common malignant neoplasia among men in Lithuania, though it presents a low mortality rate. In 2007 more than 3 500 Lithuanians were diagnosed with prostate cancer. Many patients were treated with radiotherapy. Unfortunately, after several years the number of cases of prostate cancer recurrence after radiotherapy started to grow. This new problem requires the following difficult decision to make: which treatment method to choose? Radical prostatectomy, high-dose radiotherapy, cryotherapy, high-intensityfocused ultrasound, active surveillance or hormone therapy – all are viable salvage methods. In 2012 we performed the first cryotherapy procedures. Now we want to present our first clinical experience in prostate cancer salvage cryotherapy. Materials and methods. Five patients diagnosed with prostate cancer were selected for prostate cryotherapy. Four patients were treated only with radiotherapy, one patient was treated with radiotherapy plus neoadjuvant hormonal treatment. Prostate cancer recurrences were diagnosed by multiparametric MRI and ultrasound guided transrectal or transperineal biopsies. MRI findings were validated with the Magnetic Resonance Prostate Imaging Reporting and Data System (PI-RADS). CT, MRI, ultrasound scanning, and bone scintigraphy were performed for patients before treatment. No pathological bone changes were detected. All patients received 2-cycle cryotherapy with real-time ultrasound guidance and temperature change tracking. Results. The described treatment scheme for these patients enables to deliver two freezing-thawing cycles with 10–12 probes and a urethra-warming catheter. All procedures were completed succesfully without any intraoperative complications. Urinal obstruction was observed after 1 week for 1 of 5 patients. He had to stay with epicystostomy and overwent prostate transurethral resection. After these procedures the patient could urinate normally. One patient had biochemical progression due to metastasis in parailiacal lymph nodes, and he got external beam therapy to lymph-node projection. After 6 months there was no cancer progresion signs on MRI and PSA was 1.77 ng/ml. No patients suffered from urinary incontinence. Conclusions. Our initial experience shows that cryotherapy can be a viable alternative for patients with disease progression after radiotherapy. Currently the biggest advantages of cryotherapy are as follows: possibility to treat patients not suitable for salvage prostatectomy, short hospitalization, low complication risk and lower overall cost than other methods. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.
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Bachegowda, Lohith, Diptesh Gupta, Ajoy Bharadwaj, Karthik Ranganna, TIM Adamowicz, and Anil Kumar. "Post-Renal Transplant De Novo Non-Skin Malignancies in Mycophenolate Mofetil- and Calcineurin Inhibitor-Based Immunosuppression." Blood 114, no. 22 (November 20, 2009): 1683. http://dx.doi.org/10.1182/blood.v114.22.1683.1683.
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Abstract Abstract 1683 Poster Board I-709 Introduction- Post-transplant malignancy is one of the major complications of immunosuppression in kidney transplant recipients. Mycophenolate Mofetil(MMF) and Calcineurin inhibitors(CNI) based immunosuppression is a well established combination in clinical practice. MMF has an action on cell proliferation by inhibiting Inosine Mono Phosphate dehydrogenase. However, its antitumor properties have been constantly debated. It is shown to have some antiproliferative effects in leukemias and lymphomas with a decreased incidence of PTLD. This single center study evaluated the effect of combining mycophenolate mofetil (MMF) with calcineurin inhibitors on the incidence of de novo post-transplant non skin malignancies in renal transplant recipients. We also compared the incidence of solid versus liquid cancers. Patients and Methods- Six hundred and fifty seven (657) consecutive kidney and kidney/pancreas recipients transplanted between January 2000 and December 2005 were analyzed for post-transplant malignancies. Three hundred and sixty two (362) recipients were maintained on a calcineurin inhibitor and MMF combination. The incidence of neoplasm in this group was monitored till June 2009. All patients received induction therapy with basiliximab and methylprednisolone. Steroid therapy was discontinued after the second dose in the withdrawal group. In the steroid treated group oral prednisone was initiated on day 2 at 30 mg per day and rapidly tapered to 5 mg per day at one month and continued for the life of the graft. Maintenance therapy in all recipients included both, a calcineurin inhibitor and mycophenolate mofetil (MMF). All clinical acute rejections were confirmed by biopsy and treated with intravenous methylprednisolone. Steroid unresponsive rejections were treated with Thymoglobulin Table 1 shows the demography in the CNI + MMF recipient group Recipient demography Calcineurin inhibitor/MMF group Number of recipients 362 Mean age in years 53 ± 3 Male gender 196 Deceased donor kidney recipients 305 Mean HLA antigen mismatch 3.95 ± 2.6 Pre-transplant malignancies 0 Number of recipients with rejection 71 Table 2 Incidence and type of malignancies in calcineurin inhibitor + MMF group Type of cancer Calcineurin inhibitor/MMF group Total number of recipients 362 Post transplant lymphoproliferative disease 1 Hodgkin's lymphoma 1 Renal cell cancer 6 Lung cancer 3 Prostate cancer 2 Colon cancer 2 Breast cancer 2 Bladder cancer 1 Pancreatic cancer 1 Leukemia 1 Thyroid cancer 1 Total cancers 21 (5.8%) Conclusion In our study on CNI/MMF based immunosuppression in renal transplant patients, 5.8% developed various neoplasms. There was a lower incidence of hematologic- malignancies 3/362(0.8%) in comparison to solid organ neoplasm 18/362(4.97%). The incidence of PTLD was 0.27%, which is similar to other observational studies. This could partly be due to greater expression of Inosine Monophosphate, inhibited by MMF in malignant hematologic cells. Further multicenter analysis needs to be done to detect the incidence of liquid and solid neoplasms, correlating with intracellular IMP levels with MMF usage in renal transplant recipients. Disclosures No relevant conflicts of interest to declare.
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Stolyarova, O. Y., M. I. Paliy, Y. V. Dumansky, O. V. Synyachenko, and M. V. Yermolayeva. "Factors determining the efficacy of radiotherapy for prostate cancer." Український радіологічний та онкологічний журнал 29, no. 1 (March 29, 2021): 32–44. http://dx.doi.org/10.46879/ukroj.1.2021.32-44.
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Background. Prostate cancer (PC) ranks first in the structure of oncological pathology in men, being the second leading cause of cancer death and having 30 % as the five-year survival rate. Radiation therapy (RT) for prostate cancer has great potential for enhancement.
Purpose – to evaluate the efficacy of RT in patients with prostate cancer and highlight the clinical and laboratory factors determining it.
Materials and methods. The study enrolled 195 men with prostate cancer aged 52 to 82 years. The duration from the moment of diagnosis of the disease averaged 3 years. The Gleason score parameters were 6 points on average, the ratio of peripheral to central tumor form was 3:1, adenocarcinoma was diagnosed in 94 % of cases, giant cell carcinoma – in 6 %.
Results. On average, recurring neoplasm is observed in 40 % of the patients with prostate cancer 2.5 years after radical prostatectomy combined with different methods of radiation therapy, which is associated with the initial indicators of the Gleason score, shape, localization and expansion of the tumor process, the presence of comorbid papillary carcinoma of the urinary bladder, metastases in the lymph nodes, distant viscera and the skeleton, while the power and direction of radiation exposure influence such radiotherapy complications as dermatitis, polyneuropathy, acute vascular insufficiency and tubulointerstitial nephritis.
Conclusions. Developing the medical technology for RT in patients with prostate cancer to reduce the effect of prognostically unfavorable treatment factors is essential.
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Soliman, Dina Sameh, Ahmad Al-Sabbagh, Firyal Ibrahim, Halima El-Omri, Mohamed A. Yassin, and Aliaa Amer. "Local Field Radiotherapy Induced Therapy Related Myeloid Neoplasms and Bone Marrow Suppression." Blood 134, Supplement_1 (November 13, 2019): 5113. http://dx.doi.org/10.1182/blood-2019-131683.
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Introduction: Different cytotoxic agents have been implicated in development of therapy related myeloid neoplasm (t-MN). These include alkylating agents, topoisomerase II inhibitors, antimetabolites, and ionizing field radiation given to large field including active bone marrow (BM) (Swerdlow, 2016). This report highlight the impact of local field radiotherapy on BM through discussing few patients diagnosed in our center who showed profound BM hypocellularity or developed t-MN following exposure to local field radiotherapy without chemotherapy. Local field Radiotherapy as a causative agent for t-MN: A result of retrospective study performed in our center through (2012-2018), a total of 20 patients of t-MN out of 232 total AML patients (8.6%) were detected. Two patients out of 20 (10%) in our cohort had developed t-MN following exposure to local field radiotherapy. Patient (1): 50-year old Asian male diagnosed as Vocal cord tumor, received local field radiotherapy for 2 months with no chemotherapy. 15.8 months later, he presented to with two days history of gum bleeding associated with pancytopenia (WBCx10^3/µl:2.3, Hb g/dl:6.7, Platelets x10^3/µl:100). Peripheral blood smear showed infiltration with many leukaemic promyelocytes and diagnosed as Acute promyelocytic leukemia (APL). The diagnosis was confirmed by BM examination and detection of PML RARA classic rearrangement fusion indicating PML/RARA, t(15;17) in 88.5% cells. Reticulin stain shows increased reticulin fibrosis (1-2/ 3). The patient was stratified as intermediate risk and started on ATRA followed by PETHEMA protocol with complete remission. Patient (2): A 62-year old Egyptian lady with background of hepatitis C and previous stroke, diagnosed as Endometrioid Endometrial Cancer FIGO grade I. The patient received Brachytherapy 21 Gy dose to vaginal vault, in 3 fractions (7 Gy each) without complications. 22 months later, she developed progressive neutropenia and diagnosed as high grade myelodysplastic syndrome (MDS-EB-2) with complex karyotype and P53 somatic mutation, managed by palliative therapy. Discussion: Generally laryngeal cancers radiotherapy is directed to confined area and secondary cancers are more common in the area of close proximity to radiation field. Brachytherapy is a limited source of radiation placed into a cylinder and inserted within the prostate or the vagina for treatment of cancer prostate or endometrial carcinoma respectively. Compared to external radiotherapy (RT), the limited field radiotherapy (including external beam RT and brachytherapy), the doses received by BM is very low and hence the risk of secondary leukaemia is expected to be significantly lower. Although local field RT appears to be associated with a small increase in the incidence of solid cancers, only a few studies have evaluated the risk of developing myeloid malignancies after limited field radiotherapy. Numerous cases of (t-APL) have been reported in the literature mostly following TOPO isomerase II inhibitors. However, up to our knowledge no previous reports of t-MN with recurrent genetic translocations (including t-APL) following local field radiotherapy. Local field radiotherapy induced bone marrow suppression: Two male patients with previous history of cancer prostate and limited field radiotherapy. BM examination for both patients revealed profound hypocellularity (<5-5%) with suppressed trilineage hematopoiesis. Patient (3): A 66 year-old male diagnosed as cancer prostate, subjected to radical prostatectomy, followed by salvage radiotherapy. Two months later, the patient was referred for persistent cytopenia (WBC 2.9 x10^3/uL, Hemoglobin 12.8 gm/dL and platelets (92 x10^3/uL). Follow-up revealed persistent thrombocytopenia. No follow-up BM was performed. Patient (4): A 73-year old male patient with previous history of marginal zone lymphoma and cancer prostate treated by brachytherapy. He underwent BM examination for lymphoma staging. Discussion: For patients who have received adjuvant, salvage or radical RT, a significant portion of the pelvic BM receives a substantial dose of RT. To our knowledge, there are no significant published data assessing the impact of limited field radiotherapy on BM particularly radiation induced BM suppression. Larger studies are required in order to accurately assess the actual effect of local field radiotherapy on hematopoiesis and its genetic profiling. Disclosures No relevant conflicts of interest to declare.
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Da Silva, Nizyara Costa da Silva Costa, Felipe Lima E Silva, Leonardo Magalhães Carlan, Hannah Gil De Farias Morais, Weslay Rodrigues Silva, and Maria de Lourdes Silva de Arruda Morais. "Use of antimicrobial photodynamic therapy in the treatment of medication-related osteonecrosis of the jaw." ARCHIVES OF HEALTH INVESTIGATION 10, no. 6 (July 16, 2021): 970–74. http://dx.doi.org/10.21270/archi.v10i6.5045.
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Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating complication associated with antiresorptive agents, in which treatment can be quite challenging. This study aimed to report two cases of cancer patients with MRONJ treated in a complementary manner by antimicrobial photodynamic therapy (aPDT). Both patients were male, 84 and 82 years old, respectively, and had a diagnosis of prostate adenocarcinoma and bone metastasis, treated with intravenous injections of bisphosphonates. The dental history for both was toothache, followed by extraction of dental elements that culminated with the appearance of necrotic bone in the mandibular region, which was confirmed with imaging exams and histopathological reports. The treatment protocol for both cases consisted of performing the aPDT once a week, associated with the use of 10 volumes hydrogen peroxide and 0.12% chlorhexidine digluconate for continuous use after oral brushing and amoxicillin with clavulanate three times a day for 7 days. The patient in case 1 performed 27 sessions, responded well to treatment, however, due to complications of the underlying neoplasm, he died without complete resolution of the osteonecrosis. In case 2, 32 sessions were carried out, with a good evolution of the symptoms. The patient is being followed up for 14 months, with no need for surgical intervention to date. Based on the reported cases and the literature survey, it can be concluded that aPDT can be an effective alternative in cases of MRONJ. The patients in the study in question showed success and control of the clinical picture.
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Chamberlain, Marc C., Patty A. Kormanik, and David Barba. "Complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases." Journal of Neurosurgery 87, no. 5 (November 1997): 694–99. http://dx.doi.org/10.3171/jns.1997.87.5.0694.
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✓ The authors studied complications associated with intraventricular chemotherapy in patients with leptomeningeal metastases (LM). One hundred twenty consecutive patients with LM (71 females and 49 males) ranging in age from 10 to 72 years (median 42 years) were treated with involved-field radiotherapy and intraventricular chemotherapy using an Ommaya reservoir and intraventricular catheter system. The diagnosis of LM was determined by a combination of clinical presentation (114 patients); cerebrospinal fluid cytological studies (100); or neuroradiographic studies (42). Systemic tumor histological findings included breast (34 patients); non-Hodgkin's lymphoma (22); melanoma (16); primitive neuroectodermal tumors including medulloblastoma (10); glial neoplasms, leukemia, small cell lung, nonsmall cell lung, and colon (six each); prostate and kidney (three each); and gastric cancers (two). Sixteen patients, all with non-Hodgkin's lymphoma, also had acquired immune deficiency syndrome. Patients received one to four (median two) chemotherapeutic drugs and underwent a total of 1110 cycles of intraventricular chemotherapy (median 10). Intraventricular chemotherapy administration and diagnostic Ommaya reservoir punctures totaled 4400, with a median of 46 per patient. Complications included aseptic/chemical meningitis (52 patients); myelosuppression due to intraventricular chemotherapy (21); catheter-related infections (nine); unidirectional catheter obstruction (six); intraventricular catheter malpositioning (two); Ommaya reservoir exposure (two); leukoencephalopathy (two); and chemotherapy-related myelopathy (one). There were no treatment-related deaths; however, seven patients (6%) required additional surgery for either catheter repositioning (two) or reservoir removal (five). Seven patients with catheter-related infections were treated successfully with intraventricular and systemic antibiotic drugs, thereby preserving the Ommaya system. The authors conclude that Ommaya reservoirs are convenient and pharmacologically rational systems for administering intraventricular chemotherapy. Overall, serious complications requiring surgery are infrequent (6%) and most often secondary to catheter infections, Ommaya reservoir exposure, or initial catheter malpositioning. In the majority of instances, catheter infections may be managed medically, as may the most common complications of intraventricular chemotherapy including aseptic meningitis (43% of patients) and myelosuppression (18%).
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Terekhova, Anna Leont'evna, Aleksey Vadimovich Zilov, Arkadiy L'vovich Vertkin, and Galina Afanas'evna Mel'nichenko. "Leading causes of death and concomitant pathology in patients with type 2 diabetes mellitus according to autopsy data." Diabetes mellitus 14, no. 4 (December 15, 2011): 61–64. http://dx.doi.org/10.14341/2072-0351-5819.
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Aims. The aim of this study was to estimate the prevalence rate of concomitant pathology and its influence on leading causes of death in patients withtype 2 diabetes mellitus according to clinical charts and pathologist's reports. Materials and methods. We have studied the database of Moscow City Hospital №50 in order to pick out confirmed cases of type 2 DM, treated inthe period from 2006 to 2008 years (302 patients, 9,97%). Prevalence rate of concomitant pathology and leading causes of death were then carefullystudied on this ground. Results. We examined clinical charts of 302 patients with type 2 DM - 219 female (72.5%) at the age of 76 [70;80] and 83 male at theage of 75 [68;80]. Cardiovascular pathology and cerebrovascular disease (acute cerebrovascular event and/or postinfarction encephalic cysts,discirculatory encephalopathy) (50.66%) showed high prevalence. Respiratory system diseases (25.8%), excessive body weight and obesity (21.5%),gallstone disease (19.86%), malignant neoplasm (16.2%), prostatic hyperplasia (found in 35 male patients, 42.17%), gynecologic pathology (foundin 23 female patients, 10.5%) and infectious inflammatory diseases of kidneys and urinary tract (8.6%) were also disclosed. Leading causes of deathwere found to be acute cerebrovascular events (28.8%), postinfarction cardiosclerosis (23.18%), acute/recurring myocardium infarction (19.54%)and malignant neoplasm (14.57%). High polypathy prevalence was discovered in studied cohort, and in one third of cases patients perished fromcombination of concurrent diseases.Conclusion: High prevalence rate of intercurrent diseases and polymorbidity in patients with type 2 diabetes mellitus substantiate the need for thoroughexamination at different stages of medical care, treatment of existing malfunctions, as well as preventive measures against complications.
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Miesbach, Wolfgang A., Geneth Asmelash, Birgit Puetz, Martina Boehm, and Inge Scharrer. "Manifestations of the Antiphospholipid Syndrome in Patients with Malignancies." Blood 104, no. 11 (November 16, 2004): 4039. http://dx.doi.org/10.1182/blood.v104.11.4039.4039.
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Abstract The presence of antiphospholipid antibodies has been reported in a large variety of malignancies. It is not clear, however, if the antiphospholipid antibodies are related to thrombotic associations of the antiphospholipid syndrome (APS) in these patients. We investigated the frequency of thrombotic manifestations in 58 patients with the presence of antiphospholipid antibodies and a history of neoplasia, including haematologic and lymphoproliferative malignancies. Methods Antiphospholipid antibodies were detected by clotting assay (lupus anticoagulant, LA) or by enzyme-linked immunosorbent assay (anticardiolipin antibodies). LA were tested by more than 2 different methods according to the proposed criteria of the SSC of the ISTH. Results 39/58 patients suffered from solid tumours mostly from carcinoma of the breast, prostate, and colon and 19/58 patients from malignant haematologic or lymphoproliferative diseases mostly from Non-Hodgkin lymphoma. One patient was suffering simultaneously from two carcinomas of the prostate and the testicle and a Non-Hodgkin’s lymphoma. Among the patients with solid tumours 18/39 (46 %) patients had thromboembolic complications of the antiphospholipid syndrome. Among the patients with haematologic and lymphoproliferative malignancies only 6/19 (32 %) suffered from thromboembolic complications. Thrombotic manifestations were more common on the arterial than the venous site. There was no relation between the titres of aCL antibodies and the rate of clinical manifestations. In two patients aPL disappeared after the effective treatment of the tumor. Especially patients with very high titres did not present any thromboembolic manifestation. Conclusion The presence of antiphospholipid antibodies may identify a subset of cancer patients with high risk of developing thrombotic complications but the frequency of thrombosis is lower in aPL positive patients with lymphoproliferative and haematological malignancies. Especially in these patients very high titres of aCL antibodies do not seem to be associated with clinical manifestations of the APS.
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Tichelli, André, Eric Beohou, Myriam Labopin, Gérard Socié, Alicia Rovó, Manuela Badoglio, Anja van Biezen, Grzegorz Basak, Rafael F. Duarte, and Nina Salooja. "Outcome of Patients with Second Cancer after Hematopoietic Stem Cell Transplantation: On Behalf of the Complications and Quality of Life Working Party of the EBMT." Blood 128, no. 22 (December 2, 2016): 3441. http://dx.doi.org/10.1182/blood.v128.22.3441.3441.
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Abstract Background Hematopoietic stem cell transplantation (HSCT) is potentially a curative treatment for a number of life-threatening malignant and non-malignant disorders. Despite significant improvements in outcome over time, long-term survivors are at risk for late complications and their mortality remains higher than expected. Second cancers are well-known late complications, associated with substantial mortality. Although we know the incidence and risk factors for many second cancers there is a paucity of data on their outcome after HSCT. We aimed to estimate the outcome of second cancers after HSCT using a large cohort of patients from the EBMT registry, and to compare their survival to similar cancers from a general population. Method This retrospective observational study was based on the mandatory minimum data set centers report to the EBMT. We identified all patients with second cancers (excluding malignant hematopoietic and lymphoid neoplasms; non-melanoma skin cancers) treated with HSCT in Europe (including Turkey and Israel), between 1977-2015. Primary diagnoses were acute leukemia (23%), chronic leukemia (9%), lymphoma (34%), plasma cell disorders (23%), solid tumors (4%), myelodysplastic syndromes and myeloproliferative neoplasms (6%) and acquired marrow failure syndromes (1%). For the different types of solid tumors, median and overallsurvival werecalculated (from time of diagnosis of the second cancer). Results were analyzed separately for patients treated with autologous and allogeneic HSCT (table 1). For six prevalent second cancers (breast, lung, melanoma, oropharyngeal, colorectal, prostate; table 2), the age-standardized 5-year overall survival (according to the International Cancer Survival Standard; ICSS) of HSCT patients with second cancer diagnosed since the year 2000 was compared to cancer patients from a general population (EUROCARE, European Cancer Registry, period 2000-2007). Results From the EBMT registry 4152 second cancers out of 220617 (1.88%) HSCT patients were extracted: 1450 (1.79%) out of 80784 patients after allogeneic, and 2702 (1.93%) out of 139833 patients after autologous HSCT. The median age of the patients at HSCT and at diagnosis of second cancer was 53 years (range 1.2-86) and 59 years (3.2-88), respectively. For allogeneic HSCT is was 46 years (1.2-73) and 54 years (3.2-77), for autologous HSCT, 56 years (1.7-86) and 62 years (4.5-88), respectively. The median follow-up time since transplantation of all patients was 121 months (range 5-409); it was 146 months (12-409) for allogeneic, and 114 months (5-354) for autologous HSCT. The median follow-up time since diagnosis of second cancer was 35 months (range 0-240); it was 38 months (0-240) for allogeneic, and 33 months (0-228) for autologous HSCT. The distribution and survival outcomes of second cancers are shown on table 1. Overall survival following diagnosis of second cancers depends mostly on the type of cancer. No relevant differences in median survival and 5-year overall survival were seen between patients treated with autologous or allogeneic HSCT (table 1). For second breast, lung and prostate cancers no difference in 5-year overall survival wasobserved,compared to cancer patients from a general population (table 2). Melanoma and colorectal cancers had worse, and oropharyngeal cancer better overall survival, compared to the EUROCARE control group. Conclusion This large population-based analysis on second cancers among HSCT survivors showed that the outcome for patients developing a second cancer after HSCT is mainly dependent on the type of cancer. It seems that for a number of second cancer overall survival is comparable to cancer patients from a general population. A systematic comparison is now required for all post HSCT second cancers. Disclosures No relevant conflicts of interest to declare.
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Radivoyevitch, Tomas, Rainer K. Sachs, Robert Peter Gale, Mikkael A. Sekeres, Jaroslaw P. Maciejewski, Matt Kalaycio, and Sudipto Mukherjee. "Estimating Therapy-Related Myeloid Neoplasm Risks in the US." Blood 124, no. 21 (December 6, 2014): 2617. http://dx.doi.org/10.1182/blood.v124.21.2617.2617.
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Abstract Background: Therapy-related myeloid neoplasms (t-MN) have traditionally been a dreaded but rare complication arising from the treatment of other cancers. With rising numbers of long-term cancer survivors, there is growing concern for increasing rates of t-MN. We provide estimates of the relative risks of developing these secondary cancers after various 1st cancers. Methods: We used the Surveillance Epidemiology and End Results (SEER) data 1973-2011 and the R package SEERaBomb to examine 33 primary cancer risks of subsequent MN defined as acute myeloid leukemia (AML), chronic myeloid leukemia (CML), chronic myelomonocytic leukemia (CMML), or myelodysplastic syndromes (MDS). First time cancer survivor person-years at risk (PY) for developing a second cancer were computed based on age-at-diagnosis of the first cancer, survival time, and age at diagnosis of any second cancer. Individual PY age intervals were stacked using R objects of class GRanges and the function coverage() of the Bioconductor package GenomicRanges. This yielded PY that we multiplied into age specific incidence rates computed using all t-MN regardless of being 1st, 2nd or later cancers. This yielded cases expected under a null hypothesis of t-MN being independent of prior cancers. Relative risks (RR) were then computed as observed/expected (O/E) cases and ordered by lower limit ([O - 2sqrt(O)]/E) distances from 1. PY and t-MN were restricted to those arriving after 1/1/2006 to avoid MDS incidence transients that arose immediately after its introduction into SEER in 2001. Results: 2,361 white females (Table 1), 3,415 white males (Table 2), 239 African American (AA) females (Table 3), and 309 AA males (Table 4), had t-MN diagnosed after 1/1/2006 that were known to have occurred at least 1 year after the 1st cancer. In these tables/results: RR after non-Hodgkin lymphoma (NHL), Hodgkin's disease (HD), and multiple myeloma (MM) was high, save MM in AA males; high risks after acute lymphocytic leukemia (ALL) and brain cancer were not significant for 1st cancers diagnosed >15 years of age, so these are due to childhood 1st cancers; and high risks of 2nd MN after a 1st are largely due to progressions being classified as 2nd cancers. Conclusion: t-MN with histories of NHL, HD, and MM may be enriched for truly treatment-induced cases. Mechanistic studies of t-MN should focus on such patients. Table 1. t-MN in White Females 1st Cancer O E RR ALL 16 0.6 27.4 (13.7, 41.1)* MN 99 13.3 7.5 (6, 9) NHL 235 60 3.9 (3.4, 4.4) Hodgkin's 23 4.3 5.3 (3.1, 7.6) MM 39 9.4 4.2 (2.8, 5.5) Ovarian 91 32.1 2.8 (2.2, 3.4) Brain 11 3.2 3.5 (1.4, 5.6) Lung 113 65 1.7 (1.4, 2.1) Breast 791 579.5 1.4 (1.3, 1.5) CLL 34 17.4 2 (1.3, 2.6) Other 56 31.8 1.8 (1.3, 2.2) *RR ~95% confidence intervals are given in parentheses Table 2. t-MN in White Males 1st Cancer O E RR MN 180 17.8 10.1 (8.6, 11.6) ALL 14 0.9 15.1 (7, 23.2) Hodgkin's 42 6.4 6.6 (4.5, 8.6) NHL 344 69.6 4.9 (4.4, 5.5) MM 57 13.8 4.1 (3, 5.2) CLL 77 25.2 3.1 (2.4, 3.8) CIS 243 111.2 2.2 (1.9, 2.5) Head & Neck 31 11.3 2.7 (1.8, 3.7) Lung 130 71.5 1.8 (1.5, 2.1) Other 60 29.5 2 (1.5, 2.6) Testes 29 11.9 2.4 (1.5, 3.3) Brain 14 4.6 3.1 (1.4, 4.7) Oral 75 41.6 1.8 (1.4, 2.2) Bladder 215 158.9 1.4 (1.2, 1.5) Prostate 1331 1054.8 1.3 (1.2, 1.3) Rectal 93 64.2 1.4 (1.1, 1.7) Stomach 24 13.2 1.8 (1.1, 2.6) Table 3. t-MN in AA Females 1st Cancer O E RR MN 20 1.2 16.2 (8.9, 23.4) Hodgkin's 7 0.4 17.9 (4.4, 31.5) MM 10 2.2 4.6 (1.7, 7.5) Ovarian 9 1.8 5 (1.7, 8.3) NHL 11 3.2 3.5 (1.4, 5.6) Breast 73 41.6 1.8 (1.3, 2.2) CIS 34 21.2 1.6 (1.1, 2.2) Table 4. t-MN in AA Males 1st Cancer O E RR MN 14 0.8 17.9 (8.3, 27.4) NHL 20 2.4 8.4 (4.6, 12.1) Prostate 166 92.1 1.8 (1.5, 2.1) Other 8 1.7 4.7 (1.4, 8) CIS 9 2.3 4 (1.3, 6.6) Hodgkin's 5 0.4 11.8 (1.2, 22.4) Lung 13 4.7 2.8 (1.2, 4.3) Renal 10 3.2 3.1 (1.2, 5.1) Head & Neck 5 0.5 10.8 (1.1, 20.4) Disclosures Sekeres: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen Corp: Membership on an entity's Board of Directors or advisory committees; Boehringer-Ingelheim Corp: Membership on an entity's Board of Directors or advisory committees.
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Boettge, Katherina Renate, Christoph Paasch, Mark Schrader, and Martin Strik. "Adenocarcinoma of an ileal conduit developing 8 years after cystoprostatectomy for locally advanced prostate carcinoma." BMJ Case Reports 13, no. 3 (March 2020): e227015. http://dx.doi.org/10.1136/bcr-2018-227015.
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A 70-year-old patient was treated in September 2017 for a malignancy in an ileal conduit (IC) which he received in 2009 for the treatment of prostate cancer. The tumour was found incidentally during a routine sonography. A CT scan revealed a mass near the IC. An endoscopy with biopsies showed an intraepithelial neoplasia of the ileal mucosa in the IC. We performed a segmental ileal resection. Histological findings revealed an ileal adenocarcinoma. The postoperative course was uneventful. The patient has remained alive without tumour recurrence up to the most recent negative CT screening in April 2019. Secondary malignancies after urinary diversions are a well-known complication, including procedures using small bowel parts for the urinary diversion. Adenocarcinomas arising in an IC are rarely described in literature. Concerning said tumour entity, surgical removal is often recommended. There is no evidence for the success of chemotherapy or radiation due to insufficient clinical trials. When diagnosing a mass in an IC, a secondary malignancy should be taken under consideration.
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Stojanovic, S., Lj Radosevic-Jelic, C. Tulic, I. Popov, D. Babic, M. Acimovic, and D. Masulovic. "Radical radiotherapy for localized prostate cancer in elderly." Acta chirurgica Iugoslavica 52, no. 4 (2005): 103–7. http://dx.doi.org/10.2298/aci0504103s.
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Background: Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice. Aim: The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival. Material and methods: A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A - 3 patients (2.9 %), stage B - 69 patients (67%) and stage C - 31 patients (30. l%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy. Results: Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequels (gradus I and II) are registered in 22 patients (21.36%), out of 103. Conclusion: Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long term cure.
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Tombolini, P., M. Ruoppolo, G. Dormia, and E. Dormia. "The Role of Partial Cystectomy in the Treatment of Muscle-Invasive Bladder Cancer." Urologia Journal 72, no. 2 (April 2005): 215–23. http://dx.doi.org/10.1177/039156030507200202.
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Partial cystectomy has been widely performed in the treatment of muscle-invasive bladder cancer in the 1960s and 70s. During the 1970s and 80s a more aggressive surgical approach was advocated by urologists. However, major complications occurred in 4–25% of patients undergoing radical cystectomy and urinary diversion. The overall survival in patients managed by radical cystectomy has increased during the last decades, but disease-free survival remains the same. This procedure allows excellent loco-regional tumor control, but not changes in the timing of distant metastases and in the failure to control the disease. Recently, multimodal strategies in sparing bladder surgery have been proposed. Neoadjuvant chemotherapy, with or without irradiation, allows bladder sparing surgery in selected patients. A literature review demonstrates a later recurrence in the preserved bladder ranging from 40–75%. One-third of these recurrences required cystectomy and 15–20% of cases with bladder preservation experienced disease progression and died of cancer within 2 yrs. Only 40 and 20% of T2-T3 bladder cancer patients are alive and disease-free at 5 and 10 yrs of follow-up, respectively. In our experience, in selected patients, disease-free survival, overall survival, time to progression and final bladder preservation rate was higher compared to other patients. Bladder sparing in selected patients, i.e. single non-recurrent neoplasm, favorable site, no prostatic or urethral involvement, complete response to neoadjuvant chemotherapy, no P53 overexpression, no previous BCG-failure, is a feasible approach. Cystectomy, possibly with neobladder tailoring, is currently, the standard therapy for muscle-invasive bladder cancer. A better understanding of bladder tumor disease is necessary to choose the optimal treatment and to control each individual patient.
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Kurilchik, A. A., V. S. Usachev, V. E. Ivanov, A. L. Starodubtsev, and A. L. Zubarev. "Forms of sternal reconstruction in oncology." Grekov's Bulletin of Surgery 180, no. 2 (August 20, 2021): 57–62. http://dx.doi.org/10.24884/0042-4625-2021-180-2-57-62.
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INTRODUCTION. Chest wall tumors represent a variety of morphological forms and variants of lesions. According to different authors, primary malignant tumors of the chest wall account for 0.2–2 % of all malignant neoplasms. Of them, soft tissue sarcomas constitute about 45 %. Metastatic tumors of the chest wall occur much more frequently and most commonly develop from malignant tumors of the mammary, prostate and thyroid glands, lungs, kidneys and ovaries.MATERIALS AND METHODS. The standard of the treatment of primary and metastatic tumors of the chest wall is combination or comprehensive therapy. In some cases, preoperative care allows to create a more favorable environment for performing surgical treatment being considered the best option for chest wall tumors. The choice of a technique for the replacement of the post-resection chest wall defect is of special importance to preserve the physiological chest volume, to restore chest rigidity, to prevent paradoxical respiration and to seal the pleural cavity.RESULTS. There are different surgical techniques for skeleton reconstruction. A wide range of materials used for a skeleton reconstruction include bone tissues obtained from patient’s own body (bone autoplasty, autografts), polymeric mesh (polypropylene, polytetrafluoroethylene (Gore-Tex), bone cement (polymethyl methacrylate), stainless steel and titanium constructions as well as titanium bars and rib clips (STRATOS). In spite of a large number of techniques for sternal reconstruction described in the literature, searching for new materials and ways of their usage appears relevant.CONCLUSION. Our clinical case studies demonstrate that modern reconstructive techniques combined with careful surgical planning allow to perform radical surgery with a successful outcome preventing serious postoperative complications.
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Kenzik, Kelly, Grant R. Williams, Nickhill Bhakta, Leslie L. Robison, and Smita Bhatia. "Cumulative burden of new-onset chronic health conditions (CHCs) among older cancer survivors." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 11528. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11528.
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11528 Background: In the US there are an estimated 11 million survivors of cancer diagnosed at ≥65y of age. Description of the morbidity in these survivors has been limited to single complications or to prevalence of comorbidities. The cumulative burden of CHCs remains unstudied, and is critically needed to inform healthcare delivery in this burgeoning population. Methods: Using SEER-Medicare, we identified 300,082 patients with breast (34%), prostate (33%), colorectal (16%), non-small cell lung (NSCLC 10%) or non-Hodgkin lymphoma (NHL 7%) diagnosed between 2000 and 2011 at age > 65y (mean age at diagnosis: 75y; 47% males, 88% non-Hispanic whites). An age-, race-, and sex-similar non-cancer cohort (n = 97,842) was assembled. New-onset non-malignant health conditions (n = 109) were consolidated into 10 organ-specific CHCs. Inpatient CHC visits were used to describe severe CHCs. The cumulative incidence (CI) and cumulative burden (CB) of CHCs was described up to 10y from cancer diagnosis and by attained age – up to six months prior to death or until 12/31/2013. Subsequent malignant neoplasms (SMNs) were described 10y from primary cancer diagnosis. Results: The 10y CI of any CHC and severe CHC was 98% (95%CI 98-99%) and 73% (72-73%) in cancer patients and 92% (91-92%) and 55% (54-55%) in non-cancer controls (hazard ratio [HR10y]: 1.65, 95%CI 1.64-1.66). Cardiovascular conditions were the largest contributor to severe non-malignant CHCs (10y CI: 49%-69%). Prostate cancer survivors had the highest 10y CI for SMNs (19.4%). The CI for severe CHCs was 44% by age 80y and 85% by age 90y, compared to 34% and 54% in controls (p < 0.001). The 10y CB of CHCs was highest among NSCLC (42 CHCs/survivor) and NHL (41 CHCs/survivor) survivors; in comparison, the 10y CB was 31 CHCs/individual in controls. Colorectal cancer survivors had greatest overall burden at age 80y (27 CHCs/survivor) and 90y (36 CHCs/survivor), compared to 13 and 16 CHCs/individual in controls. Conclusions: The cumulative burden of new-onset multimorbidity among older cancer survivors is substantially greater than that of their non-cancer counterparts, providing quantifiable evidence that survivor-adapted healthcare management policies and risk-based interventions are needed.
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Bamias, Aristotle, Efstathios Kastritis, Christina Bamia, Lia A. Moulopoulos, Ioannis Melakopoulos, George Bozas, Vassiliki Koutsoukou, et al. "Osteonecrosis of the Jaw in Cancer After Treatment With Bisphosphonates: Incidence and Risk Factors." Journal of Clinical Oncology 23, no. 34 (December 1, 2005): 8580–87. http://dx.doi.org/10.1200/jco.2005.02.8670.
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Purpose Osteonecrosis of the jaw (ONJ) has been associated recently with the use of pamidronate and zoledronic acid. We studied the incidence, characteristics, and risk factors for the development of ONJ among patients treated with bisphosphonates for bone metastases. Patients and Methods ONJ was assessed prospectively since July 2003. The first bisphosphonate treatment among patients with ONJ was administered in 1997. Two hundred fifty-two patients who received bisphosphonates since January 1997 were included in this analysis. Results Seventeen patients (6.7%) developed ONJ: 11 of 111 (9.9%) with multiple myeloma, two of 70 (2.9%) with breast cancer, three of 46 (6.5%) with prostate cancer, and one of 25 (4%) with other neoplasms (P = .289). The median number of treatment cycles and time of exposure to bisphosphonates were 35 infusions and 39.3 months for patients with ONJ compared with 15 infusions (P < .001) and 19 months (P = .001), respectively, for patients with no ONJ. The incidence of ONJ increased with time to exposure from 1.5% among patients treated for 4 to 12 months to 7.7% for treatment of 37 to 48 months. The cumulative hazard was significantly higher with zoledronic acid compared with pamidronate alone or pamidronate and zoledronic acid sequentially (P < .001). All but two patients with ONJ had a history of dental procedures within the last year or use of dentures. Conclusion The use of bisphosphonates seems to be associated with the development of ONJ. Length of exposure seems to be the most important risk factor for this complication. The type of bisphosphonate may play a role and previous dental procedures may be a precipitating factor.
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Kyo, Taiichi, Kouhei Kyo, Takesi Okatani, Mitsuhiro Itagaki, Ryouta Imanaka, Yuuta Katayama, Kouji Iwato, et al. "Treatment Results and Malignant Complications in Patients on Long-Term Treatment with Tyrosine Kinase Inhibitors(TKIs) for Chronic Myeloid Leukemia(CML)." Blood 120, no. 21 (November 16, 2012): 3767. http://dx.doi.org/10.1182/blood.v120.21.3767.3767.
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Abstract Abstract 3767 Background With the introduction of imatinib (IM) and subsequent TKIs such as nilotinib (NI) and dasatinib (DA), deaths due to progression of chronic myeloid leukemia (CML) have decreased dramatically. In such circumstances, the new occurrence of other malignant diseases in patients with CML on treatment with TKIs always causes distress. With the increase in long term surviving patients with CML, there is concern over whether these malignancies are related to treatment with TKIs or not. We investigated the improved prognosis in patients with CML on long-term treatment with TKIs and the occurrence of complicating malignancies. Methods We evaluated 173 patients (101 males, 72 females) in the chronic phase of CML, all of whom had CML diagnosed at our hospital between January 1990 and June 2011 and received treatment with TKIs for at least 1 year. The median age at the start of treatment with TKIs was 57 (19 – 92) years. Patients aged 60 years and older accounted for 72 (42%). The median follow-up period after the start of treatment with TKIs was 68 (12 – 128) months. Before the onset of CML, 11 patients had prior malignancies. Treatments for CML administered before use of TKIs were hydroxyurea (HU) alone 3, HU + interferon-α (IFN-α) 47, IFN-α alone 7, chemotherapy for AML + IFN-α 2 and chemotherapy for ML + IFN-α 1. TKIs were used as frontline therapy in 113.TKI treatment of all patients initially consisted of IM at the dose of 100 mg per 12 kg body weight. We switched the drug to NI when complete molecular response (CMR) was not achieved after long-term treatment with IM. In addition, a switch to DA was used to consolidate CMR. Treatments that contained TKIs consisted of IM alone in 42, IM → NI in 46, and IM →NI → DA in 85. Two patients with a complete cytogenetic response (CCR) underwent bone marrow transplantation. Results Among 173 patients, the best response to treatment in patients treated with TKIs was CMR in 72, a major molecular response (MMR) in 84, CCR in 15, and refractory CML in 2. Currently, 22 have maintained CMR for 6 to 111 months after discontinuation of TKIs, and 19 (11%; 17 males, 2 females) have developed new onset of a malignancy. In these 19, the median age at the onset of cancer was 70 (31 – 85) years. Patients aged 60 years and older accounted for 15 (79%). The median period from the start of TKIs to the onset of cancer was 38 (10 – 117) months. Affected organs were bladder 5; stomach 3; rectum 3; large intestine 2; lung 2; and esophagus, appendix, prostate, and pancreas each in 1. The TKIs given to the patients with malignant diseases were IM alone in 13, IM → NI in 4, and IM → NI → DA in 2. Prior treatments included HU + IFN-α in 8 and IFN-α alone in 1. The observed number of patients who were diagnosed as malignant neoplasm was compared with the expected number. The expected number was obtained through integration of age specific incidence rate of malignant neoplasm from the start age taking medicine to the age at which the diagnosis as malignancy was made or the follow up was finished for censoring. The age specific incidence rates were estimated by interpolating five year old specific incidence rates from of the 2007's survey that was conducted by Center for Cancer Control and Information Services, National Cancer Center, Japan. The observed number/expected number (O/E) ratio for the occurrence of all malignant diseases was 1.00 (19/18.97), and the O/E for gastrointestinal cancer was 1.118 (11/9.84). Therefore, no increase in the incidence of malignant diseases was observed in patients treated with TKIs. However, the O/E for bladder cancer was 4.525 (5/1.11) with a 95% confidence interval of 1.42 – 9.32 (P = 0.0002), which means that the incidence of bladder cancer in patients treated with TKIs was higher than that in the general Japanese population. So far 19 patients have died and the median age at death was 79 (59 – 94) years. In these patients, 8 deaths were related to cancer and the others were caused by diseases associated with old age that were unrelated to the worsening of CML. Conclusion The introduction of TKIs has undoubtedly improved the prognosis of patients with CML. Based on the results of this investigation, the apparent increase in malignant diseases observed during the long-term follow-up of patients treated with TKIs was generally considered to be attributable to the aging of patients. We should however further investigate whether the higher incidence of bladder cancer seen in patients treated with TKIs is incidental or not. Disclosures: No relevant conflicts of interest to declare.
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Pozzi, Samantha, Raffaella Marcheselli, Stefano Sacchi, Giovanni Quarta, Pellegrino Musto, Giuseppe Caparrotti, Donato Natale, et al. "Analysis of Frequency and Risk Factors for Developing Bisphosphonate Associated Osteonecrosis of the Jaw." Blood 106, no. 11 (November 16, 2005): 5057. http://dx.doi.org/10.1182/blood.v106.11.5057.5057.
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Abstract Although the evidence available associating bisphosphonates (BP) with osteonecrosis of the jaw (ONJ) is far from conclusive, the growing literature reports strongly suggest a strict relationship between them. The real frequency of this complication is unknown because of the recent observation of this condition, the bias related to retrospective studies and the wide-spread use of this supportive therapy. Aims of this research were to look for additional risk factors for developing ONJ and to determine the frequency of this event in the subgroup of patients affected by Multiple Myeloma (MM) treated with BP. We asked 49 GISL centers to participate in a retrospective multicenter study filling out a form containing several queries, including sex and age, anamnesis for smoke habit, anemia and thrombotic events, type and time of neoplasia diagnosis, treatment and neoplasia status, odonthoiatric anamnesis, type and duration of therapy with BP, microbial isolation in site of lesion, specific treatment for osteonecrosis, number of patients (pts) affected by MM treated with BP from 2002 to 2005. Fifteen centers decided to participate in the study and 12 had cases of osteonecrosis. ONJ was reported in 19 pts. Sixty % were females and the median age was 65 ys. Sixteen had MM, 1 breast cancer, 1 prostatic cancer, 1 osteoporosis steroid related. Median time from diagnosis of cancer was 54 months and median duration of treatment with BP was 34 months. Thirteen events manifested between 20 and 60 months. Of the 19 pts, 8 had received zolendronate, 2 pamidronate and 9 both drugs. None had radiotherapy on head and neck, while two received total body irradiation. In these two cases, ONJ was associated with necrosis of the pelvis. The 2 solid tumors were treated with ormonal therapy. All MM pts had received one or more line of treatment including, VAD, MP, steroids and thalidomide alone or in combination, as well as high dose melphalan, as part of autologous bone marrow transplant. ONJ involved the mandible in 14 pts, the maxilla in 3 and both in 2. Symptoms included local pain and discomfort. In 17 cases CT scan was the strumental procedure used to identifiy the lesion. In 14 pts biopsy was performed excluding localization of neoplasia in 11 cases. Microbiological evaluation of the lesion was positive in 11 pts, with 6 cases of Actynomices. In 12 patients ONJ was apparently spontaneous; in 7 occurred after dental procedures. Parodonthopaties were present in 10 pts. In 11 cases ONJ was complicated by fistula, exposed bone or abscess. BP were stopped in 17 pts. Antibiothic therapy was administered in 17 cases; 7 pts underwent hyperbaric oxygen therapy and 8 surgical debridement. Several pts improved but none were cured. Considering only the MM subgroup 16 cases of ONJ were identified among 888 pts treated with BP between 2002 and 2005, with a frequency of 1.8%. Utilizing the data collected by our retrospective study a fine statistical analysis is not applicable. However, in MM pts the frequency of steroid treatment, parodonthopaties and anemia was particularly high, respectively 100%, 56%, and 56%, supporting the idea that these are additional risk factors for developing ONJ.
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Morton, Lindsay M., Graca M. Dores, Meredith S. Shiels, Martha S. Linet, Jop C. Teepen, Clara J. K. Lam, Margaret A. Tucker, and Rochelle E. Curtis. "Emerging Risks of AML/MDS and Other Myeloid Neoplasms Following Chemotherapy for First Primary Malignancy, 2000-2012." Blood 126, no. 23 (December 3, 2015): 562. http://dx.doi.org/10.1182/blood.v126.23.562.562.
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Abstract Introduction. Treatment-related acute myeloid leukemia/myelodysplastic syndrome (tAML/MDS) is a rare but often fatal complication of systemic therapy for primary malignancy. Leukemogenicity of specific agents is variable, with particularly high risks associated with platinum-containing agents, certain alkylating agents, topoisomerase II inhibitors, and purine analogs. Current treatment practices increasingly include (neo)adjuvant and multiple courses of systemic therapy for a number of first primary malignancies. However, no large-scale study has quantified risks of tAML/MDS and other myeloid neoplasms after chemotherapy in the modern treatment era. Methods. We identified a cohort of 746,007 adults who were initially treated with chemotherapy and survived ≥1 year following diagnosis with first primary malignancy during 2000-2012, as reported to 17 US population-based cancer registries from the Surveillance, Epidemiology, and End Results program. Risks for second primary AML/MDS, chronic myeloid leukemia (CML), and other myeloproliferative neoplasms (MPNs) and MDS/MPNs were compared to that expected in the general population (based on age-, race-, sex- and calendar period-specific incidence rates) using standardized incidence ratios (SIRs). Results. tAML/MDS was identified in 2071 individuals following chemotherapy, four times more than expected based on general population rates (SIR=4.1, 95%CI=3.9-4.2). We identified novel elevations in tAML/MDS risk after chemotherapy for most gastrointestinal malignancies, including the oral cavity/pharynx (N=45, SIR=2.6, 95%CI=1.9-3.5), esophagus (N=28, SIR=4.3, 95%CI=2.9-6.2), liver (N=10, SIR=2.6, 95%CI=1.2-4.8), stomach (N=22, SIR=2.7, 95%CI=1.7-4.0), rectum (N=65, SIR=1.5, 95%CI=1.2-1.9), and anus (N=22, SIR=3.6, 95%CI=2.3-5.5), but not colon (N=67, SIR=1.1, 95%CI=0.8-1.3). Novel increased risks of tAML/MDS also were observed after chemotherapy for cancers of the pancreas (N=15, SIR=3.3, 95%CI=1.8-5.4), larynx (N=20, SIR=4.2, 95%CI=2.6-6.5), bladder (N=30, SIR=1.8, 95%CI=1.2-2.6), and melanoma (N=4, SIR=3.7, 95%CI=1.0-9.6) Similar to previous studies, tAML/MDS occurred most commonly after female breast cancer (N=543, SIR=4.1, 95%CI=3.8-4.5), non-Hodgkin lymphoma (NHL; N=515, SIR=7.3, 95%CI=6.7-7.9), and lung cancer (N=185, SIR=4.1, 95%CI=3.5-4.7). We further confirmed previous observations of strikingly elevated risks of tAML/MDS after chemotherapy for cancers of the bone (N=10, SIR=35.1, 95%CI=16.9-64.6), testis (N=18, SIR=15.6, 95%CI=9.2-24.6), and soft-tissue (N=20, SIR=12.6, 95%CI=7.7-19.4), and more modestly elevated risks of tAML/MDS after chemotherapy for cancers of brain (N=18, SIR-7.8, 95%CI=4.6-12.4), ovary (N=84, SIR=5.5, 95%CI=4.3-6.7), endometrium (N=28, SIR=4.4, 95%CI=2.9-6.3), cervix (N=22, SIR=4.4, 95%CI=2.8-6.6), and prostate (N=15, SIR=2.7, 95%CI=1.5-4.4), as well as Hodgkin lymphoma (N=54, SIR=8.7, 95%CI=6.6-11.4), chronic lymphocytic leukemia (N=52, SIR=7.7, 95%CI=5.8-10.2), and myeloma (N=102, SIR=6.3, 95%CI=5.1-7.6). Risks were non-significantly heightened with radiotherapy plus chemotherapy for breast, lung, and stomach cancers compared with chemotherapy alone. Elevated risks also were observed for CML after chemotherapy for lung cancer (N=12, SIR=2.5, 95%CI=1.3-4.4), breast cancer (N=35, SIR=1.8, 95%CI=1.3-2.5), and NHL (N=16, SIR=2.1, 95%CI=1.2-3.4), and for chronic myelomonocytic leukemia after chemotherapy for breast cancer (N=15, SIR=3.0, 95%CI=1.7-5.0) and NHL (N=16, SIR=4.2, 95%CI=2.4-6.9). In contrast, risks were not increased for other MPNs after chemotherapy for any first primary malignancy. Conclusions. Despite the availability of modern cancer chemotherapy and targeted agents, risks of tAML/MDS are elevated across a broad spectrum of first primary cancers and extend to other myeloid neoplasms. Risks are consistent with those expected from expanded use of leukemogenic systemic therapy, particularly for specific cancers, such as cervical cancer, that are commonly treated with platinum-based regimens. More research is needed to quantify risks associated with specific agents and doses in the (neo)adjuvant and treatment setting. Risks for treatment-related myeloid neoplasms should be weighed against benefits of systemic therapy. Disclosures No relevant conflicts of interest to declare.
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Vidal, M., A. Ferrer, S. Serrano, M. Tobeña, I. Pajares, D. Lopez, E. Millastre, M. Ruiz-Echarri, J. Lambea, and A. Tres. "Fever in cancer patients as a cause of attendance in emergency room." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20706-e20706. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20706.
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e20706 Background: Normal human body temperature displays a circadian rhythm, ranging from 36.1 C or lower in predawn hours to 37.4 C or higher in the afternoon. Abnormal elevation of temperature occurs as a result of hyperthermia or fever. Cancer patients frequently experience fever. Nearly two-thirds of the cases of fever in patients with prolonged neutropenia could be attributed to infection, a major cause of morbidity in cancer patients. Purpose: The aim of our study is to evaluate the prevalence of cancer patients who were attended in the emergency room for fever, the diagnosis and clinical management. Methods: From October 2007 to October 2008, 560 cancer patients were seen in the emergency department of the University Hospital of Zaragoza. The purpose of this paper is to describe the characteristics of patients who presented with fever. Results: A total of 560 patients were seen. Ninety-eight (17.5%) presented with fever. 63% of patients were stage IV. Cancer tumor type, 35 had lung cancer (35.7%), 14 had breast cancer (14.3%), 9 had colorectal cancer (9.2%), 9 had urothelial cancer (9.2%), 5 had head neck cancer (5.1%), 5 had pancreatic cancer (5.1%), 3 had esophageal cancer (3%), 2 had prostate cancer (2%), and 14,3% had other neoplasm. 18 patients (18.36%) had been received chemotherapy treatment in a period of 10 days before. they were attended in emergency room. By diagnosis: 23 patients (23,46%) were diagnosed of febrile neutropenia, and 19 of them (82,6%) required admission to the hospital. 30 were diagnosed of respiratory tract infection (30,6%), 12 were diagnosed of urinary infection (12.24%). Considering all the patients who presented with fever: 45 patients were sent home with new treatment (45,9%), 6 patients were observed for 24 hours in the emergency room (6.2%) and 47 patients required admission to the hospital (47.9%). Conclusions: Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. Infection in the immunocompromised host is a serious clinical situation due to high morbimortality and is one of the most frequent complications in the patient with cancer. No significant financial relationships to disclose.
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Kleber, Martina, Kerstin Höck, Gabriele Ihorst, Bernd Koch, Ralph Waesch, and Monika Engelhardt. "Risks for Different Neoplasms (DNs) in Multiple Myeloma (MM) Patients May Involve Specific Host-, Myeloma- and Treatment-Related Susceptibilities: Registry Data of 681 Consecutive MM Patients,." Blood 118, no. 21 (November 18, 2011): 3929. http://dx.doi.org/10.1182/blood.v118.21.3929.3929.
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Abstract Abstract 3929 Introduction: MM has envisioned numerous innovations, resulting in prolonged overall survival (OS), nevertheless, long-term complications may comprise the occurrence of different neoplasms (DNs). Recently, DNs after novel agent first-line- and maintenance-treatment have been reported, questioning whether specific risk factors (RFs) predispose to DNs. SEER and Swedish registry data on DNs have observed overall cumulative incidences of 5.1–5.5% in MM, and Mailankody et al. (Blood 2011) standardized incidence ratios in MM- and MGUS-patients for AML/MDS of 11.51- and 8.01-fold, respectively. In a previous registry analysis, we demonstrated an impaired prognosis in MM with subsequent DNs (HR 2.5; 95% CI 1.4–4.4) and that age >60 years was a confounding variable (HR 2.021; 95% CI 1.6–2.6; Hasskarl et al. 2011). Albeit previous analyses have focussed on subsequent DNs, rather than prior and synchronous (p/s) DNs (since the latter needs to live long enough to acquire MM), we assessed both, since p/s DNs is even more pertinent, both phenomenon need to be known to MM experts and should allow to define host-, MM- and/or therapy-related risks. Methods: We assessed 681 consecutive MM patients treated at our institution between 1997 and 2011 and analyzed 1. patient characteristics (age, gender, familiar risks, smoking-, immune status), 2. frequency of DNs, 3. potential MM-specific RFs (stage, albumin, ß2-microgloblin (ß2-MG), bone marrow (BM) infiltration, cytogenetics), and 4. possible treatment-related RFs (novel agents, autologous stem cell transplantation [single vs. tandem (t)-ASCT], allogeneic (allo-) SCT, frequency of alkylating agents, cycles/lines of therapy and ionizing radiation). Results: Of 681 MM patients, 91 (13%) showed DNs: ¾ (76%) had solid tumors (ST) and ¼ (24%) hematological neoplasms (HM). p/s DN were observed in 2/3 (n=63; 69%) and subsequent DNs in 1/3 (n=28; 31%). The median age of MM patients with additional DNs was 68 (range 39–89), which was older than our tertiary/referral center's usual MM age (Kleber et al. 2009, Hasskarl et al. 2011). DNs occurred in preferentially males (69%), predominantly in IgG- or IgA-MM and in advanced (II/III) Durie & Salmon [D&S] stages (80%). The comparative analysis of MM with subsequent DN vs. those with p/s DN revealed a younger age with 62 vs. 68 years, respectively; subsequent vs. p/s DNs had an IgG MM-subtype in 75% vs. 66%, and HM occurred in 32% vs. 21%, respectively. Subsequent DNs showed most prominently AML/MDS in 7 patients; lymphoma and CML were observed in one patient each. ST-entities were lung-, colorectal- and urothelial-cancer in each 4 patients, breast-, oropharyngeal- and skin-cancer in each 2 patients and prostate cancer in one patient. Single or t-ASCT had been performed more frequently in MM patients with subsequent DNs as opposed to those with p/s DNs, but bortezomib- and thalidomide were less often applied and allo-SCT, alkylators and lenalidomide comparable. Subsequent DN and p/s DNs patients did not reveal substantial differences in terms of D&S or ISS stage, BM-infiltration rate, gender- or smoking-status, albeit the family risk for cancer was different with 3% and 21%, respectively. Comparison of subsequent-HM vs. -STs in MM patients showed a more advanced age with 71 vs. 60 years. Males were less prominent in MM patients with HM than ST (33% vs. 89%, respectively). Alkylators had been used in 89% of HM compared to 68% with subsequent ST, albeit median therapy lines were comparable. MM patients with subsequent HM had received less single (22%), t-ASCT (22%), allo-SCTs (0%) and radiation (22%) compared to MM with ST (42%, 32%, 11%, 47%, respectively). Lenalidomide, bortezomib or thalidomide had been used less frequently in MM patients with subsequent HM (n=1) than with ST (n=5). No differences were evident in MM-specific RFs (stage, albumin, ß2-MG, BM-infiltration). Conclusions: Our current data highlight the substantial risk for developing DNs in MM patients. We propose specific host- (age, gender, smoking) and treatment- (alkylators, ASCT/allo-SCT) related susceptibilities that may predispose to MM and subsequent DNs. Further analyses are underway to evaluate these and other potential RFs (cytogenetics, immunologic alterations) in comparison to MM patients without DNs and in relation to the German general population and SEER-data. Disclosures: No relevant conflicts of interest to declare.
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Weinreb, Neal J., Deborah Barbouth, and Robert E. Lee. "Causes of Death in 184 Patients with Type 1 Gaucher Disease From the United States Who Were Never Treated with Enzyme Replacement Therapy." Blood 118, no. 21 (November 18, 2011): 3128. http://dx.doi.org/10.1182/blood.v118.21.3128.3128.
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Abstract Abstract 3128 Type 1 Gaucher disease (GD1) is caused by deficient lysosomal glucocerebrosidase activity with resultant accumulation of glucosylceramide predominantly within hepatic, splenic, pulmonary and bone marrow macrophages. Intravenous recombinant glucocerebrosidase (ERT) is generally safe and effective in decreasing morbidity due to the heterogeneous manifestations of GD1: hematological cytopenias, hepatosplenomegaly, bone pain, osteonecrosis, osteopenia and fractures. There are other complications whose responsiveness to conventional treatment is yet undetermined: atypical Parkinsonism and an increased risk for cancer (CA), particularly plasma cell and other hematological and lymphoid malignancies and hepatocellular carcinoma. Because of the widespread use of ERT during the past 20 years and attrition of older medical records, a phenotypically representative control group of untreated symptomatic patients for study of these late outcome events is hard to find. From 1961–97, one of us (REL) collected information on 395 US patients with GD1. We determined through public records that 217 died from 1950–2010 of whom 184 never received ERT. Here, we report confirmed causes of death (COD) for the untreated GD1 patients compared to COD reported for this time period in an age comparable overall US population. Methods: After IRB approval, COD recorded in death certificates were accessed via the National Death Index for available years 1979–2008. COD prior to 1979 were determined based on autopsy or physician communication with REL and, where possible, by death certificates obtained from State Bureaus of Vital Records. Information on COD (1950–2008) for the general US population is from US National Vital Statistics Reports. The analysis included descriptive statistics, calculation of proportional mortality ratios (PMR), and 2-tailed Fisher exact test calculations based on absolute death numbers in the GD1 and general populations. Results: COD is unknown for 9 patients who died before 1979. 111 pts were male (60.3%); 124 (67.4%) were Ashkenazi Jewish. Median age at death was 66y (2–97y). Median age at GD1 diagnosis (N=102): 39y (1–83y). Spleen status: Splenectomy 94 (51.1%); Intact 56 (30.4%); Unknown 34 (18.5%). Median age at splenectomy: 36y (1.3–78y). Symptomatic bone disease was present in 74 (40.2%), absent in 7 (3.8%) and undocumented for 103 (60.0%). COD for which the PMR was significantly increased (P<0.01): malignant neoplasms (PMR 1.57), suicide/drug overdose (PMR 3.86), chronic liver disease (PMR 4.76) and septicemia (PMR 9.22). Other COD that were disproportionately high included CNS and gastrointestinal bleeding, post-splenectomy complications, pulmonary hypertension (PHT), and Parkinsonism. Heart disease/atherosclerosis was the only COD for which PMR was very significantly decreased (0.33). PMR for cerebrovascular disease was 0.48 (P=0.027). For 57 pts with a CA COD, PMRs for myeloma (9.66), kidney CA (4.63), liver CA (4.36), NHL (4.13), and all leukemia (3.19) were significantly elevated (P<0.01). Conversely, the PMR for lung CA was 0.32 (P=0.002). There was 1 death from breast CA and none from gynecological CA. PMR for colorectal, pancreatic and prostate CA were not divergent from expected. Compared to the control population, the age distribution of deaths was identical for heart disease, septicemia, and suicide. Age at death was not younger than expected in pts with myeloma but there was a tendency for death at a younger age for GD pts with NHL, chronic liver disease and Parkinsonism. COD significantly more prevalent in surgically asplenic pts included chronic liver disease, septicemia, GI bleeding, PHT and post-splenectomy complications. Spleen status was statistically irrelevant to CA deaths including myeloma except for hepatocellular CA (splenectomy) and CLL (intact spleen). Conclusions: With earlier diagnosis, improved risk assessment and phase-out of splenectomy, COD that we encountered (chronic liver disease, GI bleeding, septicemia, PHT, suicide and drug dependency) should be increasingly rare with timely institution of appropriate treatment. Our study population of untreated pts (estimated at 5% of all US GD1 deaths from 1950–2008 but a substantially greater percentage of GD1 deaths over age 60y), should serve as a valuable control for future studies of the effect of GD1 treatment on mortality due to malignancy or other later course events. Disclosures: Weinreb: Genzyme Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Shire HGT: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Actelion Corporation: Speakers Bureau.
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Garcia Ruiz, Maria Almudena, Francisco Jose Romero Martinez, Estefania Morente Constantin, Margarita Gomez Morales, and Manuel Jurado. "Continued Use of Tinzaparin at Therapeutic Doses for Prophylaxis of Venous Thromboembolism in Patients with Intolerance to Antivitamins K." Blood 126, no. 23 (December 3, 2015): 4735. http://dx.doi.org/10.1182/blood.v126.23.4735.4735.
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Abstract OBJECTIVES The low molecular weight heparins (LMWH) are typically administered at fixed doses like thromboprophylaxis or at doses adjusted to the weight of the patient in order to obtain a therapeutic effect. Generally they do not require laboratory monitoring, although it could be considered in special situations (renal failure, extreme weights, pregnant women). The LMWH do not affect the APTT, so it has been proposed to determine the anti-factor Xa activity when it is necessary to monitor its effect. The anti-factor Xa activity should be determined approximately 4 hours after sc administration of the LMWH that it is employed, concurring with the peak of activity. The therapeutic range of the anti-factor Xa activity is between 0.6 and 1 IU / mL when LMWH is administered every 12 hours. At single daily dose is less clear, although it seems that lies above 1 IU / mL. Nowadays, LMWH are the anticoagulant of choice during pregnancy. Numerous in vitro and in vivo studies have shown the existence of an antineoplastic effect of heparin. LMWH is commonly used for prolonged treatment of thrombosis associated with cancer. METHODS The main aim of our study is to evaluate the efficacy of tinzaparin sodium at therapeutic doses in preventing VTE in renal failure, active cancer and/or patients with contraindications to oral anticoagulation. The dose has been therapeutic and adjusting it has been made in terms of anti-factor Xa levels obtained monthly. Hemorrhagic or thrombotic complications and other possible side effects have been assessed. Until now, a total of 70 patients, 42 men and 28 women aged between 30 and 95 years old, have received tinzaparin sodium treatment. The main reason of anticoagulation are: atrial fibrillation and atrial flutter (with or without valve disease), VTE (with or without thrombophilia), stroke and transient ischemic attacks and mechanical prosthetic aortic and mitral valves (some of the patients carrying a double metal prosthesis). There was 1 resistance and 1 allergic reaction to anti-vitamin K. 4 of the patients were pregnant and 14 had renal failure. Prior to initiation of therapy, analytical determinations were performed, including: blood count, blood coagulation and biochemistry to assess renal function (urea and creatinine). 20 patients (14 were anticoagulated by atrial fibrillation, 2 for bearing a mechanical aortic prosthesis and 4 because of DVT, 1 of which had also a TEP) had active cancer or were in remission from their neoplasia (3 multiple myeloma, 1 LAM, 1 CMML, 4 renal tumors, 1 lung cancer, 5 prostate cancers, 1 hepatocellular carcinoma, 2 colon cancer, 1 endometrial adenocarcinoma and 1 retroperitoneal leiomyosarcoma). 1 with MDS was treated with LMWH because he had intra- and extrahepatic portal vein thrombosis. RESULTS Some of the patients had received prior treatment with anti-vitamin K (INR objective depending on pathology) but, in other cases, the low molecular weight heparin was the only treatment since the beginning of their anticoagulation. All the patients had received 175 IU / Kg of Tinzaparin Sodium once a day as initial dose, then the dose was adjusted according to the anti-factor Xa levels. They were controlled until 31/07/2015. In terms of side effects, 8 patients presented complications: 3 mucosal bleeding, 2 episodes of stroke in a patient, hemoptysis, deep vein thrombosis and 2 bleeding at the puncture site of heparin, which have not required discontinuation of therapy. When these complications occurred, we proceeded to the corresponding heparin dose adjustment based on new determinations of anti-factor Xa. CONCLUSIONS Although only in 70 cases, the results obtained confirm the efficacy, safety and cost-effectiveness of the continuous use of LMWH. Determination of anti-factor Xa levels are considered very useful for dose adjustment parameter. In our study, tinzaparin sodium has proved to be very useful in preventing venous thromboembolism associated or not with cancer, in patients with conditions requiring anticoagulation and presenting contraindications to the use of anti-vitamin K. The results obtained have demonstrated that tinzaparin is safe and, most likely, further studies will provide valuable confirmation data to support the use of low molecular weight heparins in the prolonged treatment of patients who require oral anticoagulation and can not receive it. Disclosures No relevant conflicts of interest to declare.
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Rummel, Mathias J., Aline Tenzer, Norbert Niederle, Chrisoph Losem, Christina Balser, Harald-E. Balló, Manfred Welslau, et al. "No Elevated Rates of Treatment-Related Myelodysplastic Syndromes and Second Solid Tumors Following Therapy with Bendamustine Compared with Other Anti-Lymphoma Regimes for Low-Grade Non-Hodgkin's Lymphoma." Blood 116, no. 21 (November 19, 2010): 3090. http://dx.doi.org/10.1182/blood.v116.21.3090.3090.
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Abstract Abstract 3090 Introduction: Long term survival among patients (pts) with low grade/indolent Non-Hodgkin lymphoma (iNHL) is increasingly common, and as a consequence, a consideration of potential therapy-related sequelae, such as secondary neoplasia (sNPL), is of particular importance. Bendamustine plus rituximab (B-R) is an effective treatment option with a favorable toxicity profile in pts with iNHL. However, no data have been reported concerning later, therapy-associated complications with B-R. The aim of this study was to determine the incidence of therapy-related myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and solid tumors after B-R, in comparison with other anti-lymphoma chemotherapy regimens, in pts with follicular (FL), other indolent or mantle cell lymphoma (MCL). Patients and methods: Data for this analysis were obtained from 2 randomized studies, including a total of 697 pts: 1) StiL-study NHL-1, comparing B-R (bendamustine 90 mg/m2, d1+2, rituximab 375 mg/m2, d1; q 28 days) with CHOP-R (q 21 days) as first-line therapy in 513 pts (260 B-R, 253 CHOP-R) (median age 64 yrs, range 31–83); 2) StiL-study NHL-2, comparing B-R with F-R (fludarabine 25mg/m2, d1–3, rituximab 375mg/m2, d1; q 28 days) in 184 pts (median age 68 yrs, range 38–87) with relapsed disease (96 B-R, 88 F-R). Patients in this NHL-2 study had received a median of 1 prior therapy (range 1–7). Result: At the time of this analysis (May 2010), the median observation time was 35 months for NHL-1 pts and 33 months for NHL-2 pts. Most pts in both studies received 6 cycles of therapy. In the NHL-1 study, 16 pts (6.2%) developed sNPL after B-R as first-line treatment, compared with 19 (7.5%) after CHOP-R. Most (87.5%) sNPL were solid tumours: 4 gastrointestinal, 4 urothelium, 2 prostate, 2 squamous epithelium, 1 bronchial, and 1 adrenal after B-R; 6 gastrointestinal, 5 prostate, 3 bronchial, 2 breast, 1 melanoma, 1 urothelium, and 1 endocrinal pancreas after CHOP-R. The rate of secondary hematological NPL did not differ between arms; 1 MDS and 1 T-cell-lymphoma after B-R, 1 AML and 1 Hodgkin lymphoma after CHOP-R. The median time from initiation of study therapy to diagnosis of sNPL was 18.5 months for B-R, and 14 months for CHOP-R. 5 pts in the B-R group, and 2 in the CHOP-R group received additional chemotherapy after completing study therapy, and before diagnosis of sNPL. In the NHL-2 study, 6 pts (6.3%) developed sNPL after B-R as relapse therapy, compared with 9 (10.3%) after F-R (p=0.42). Of these, 3 pts in the B-R group, and 2 pts in the F-R group developed a secondary hematological NPL (2 MDS, 1 Hodgkin lymphoma after B-R; 2 AML/MDS after F-R). Solid tumors were observed in 3 pts following B-R (2 urothelium, 1 squamous epithelium), and in 8 pts following F-R (3 squamous epithelium, 2 bronchial, 1 gastrointestinal, 1 urothelium, 1 anal). The median time from initiation of study therapy to diagnosis of sNPL was 33 months for the B-R group and 24.5 months for the F-R group. Conclusion: This ongoing evaluation shows comparable rates of secondary MDS/AML and other sNPL between B-R and CHOP-R or F-R. This observation, combined with data from other studies showing improved efficacy with B-R compared with CHOP-R or F-R, confirm the value of B-R as a treatment option in patients with follicular, indolent or MCL. Longer follow-up of the patient cohorts reported here will provide important additional information on the rate of sNPL with B-R compared with other anti-lymphoma regimens. Disclosures: No relevant conflicts of interest to declare.
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Gowin, Krisstina, Caroline Irene Piatek, Siamak Saadat, Karren Cuadra, Pedram Razavi, Ronald Tang, and Casey L. O'Connell. "Patients with Polycythemia Vera and Essential Thrombocytosis Have a Higher Risk of Prior or Concurrent Tumors Compared to Patients with Secondary Thrombocytosis." Blood 116, no. 21 (November 19, 2010): 3084. http://dx.doi.org/10.1182/blood.v116.21.3084.3084.
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Abstract Abstract 3084 Background Polycythemia vera (PV) and Essential thrombocytosis (ET) are chronic myeloproliferative neoplasms (MPNs) that arise from aberrant, clonal hematopoietic stem cells. MPNs are associated with an elevated risk of arterial and venous thrombosis as well as with transformation to myelofibrosis (MF) and acute myeloid leukemia (AML). Diseases causing secondary, or reactive, elevation of the red cell or platelet counts are not considered clonal and do not predispose to the development of hematologic malignancies. Prior reports in patients of European descent suggest as many as 15% of patients with MPNs die of unrelated malignancies, but there is no data suggesting that these malignancies precede the MPN diagnosis. In a large, ethnically diverse population, we investigated whether tumors other than MF or AML (“unrelated tumors”) occurred more commonly among patients with ET and PV than among patients with secondary thrombocytosis. Methods We performed a retrospective chart review of all consecutive patients diagnosed with ET, PV or secondary thrombocytosis (ST) between April, 1992 and June, 2010. Laboratory data and the World Health Organization criteria were utilized to distinguish ET, PV and ST. In addition to demographic and MPN-specific diagnostic data and complication rates, we recorded the prior or concurrent, pathologically-confirmed diagnosis of unrelated tumors, their histology and treatment received. We performed a multivariate, exact logistic regression analysis adjusted for age at diagnosis of MPN, sex, ethnicity, JAK2 mutational status and MPN subtype to determine whether MPN patients are more likely to have had unrelated tumors than ST patients. Results Seventy-six patients with MPNs, 55 with ET and 21 with PV, were compared to 82 patients with ST. The median age at diagnosis in the MPN group was 53.5 years (range 19 –84); it was 46 years in the ST group (range 16 – 87). The majority (57.9%) of the patients with MPNs were Hispanic whites, 21% were Asian, 15.8% were non-Hispanic whites, and 5.3% were Black. Of the 82 patients with ST, 73.2% were Hispanic whites, 9.8% were Asian, 9.8% were Black and 4.9% were non-Hispanic whites. Thrombosis occurred in 12 (15.8%) of the MPN patients and in none of the ST patients. We observed a statistically significantly higher incidence of unrelated tumors in MPN patients (17.1%) as compared to ST patients (1.2%). The multivariate analysis revealed an odds ratio for unrelated tumors among MPN patients of 5.19 (95% CI 1.04 – 22.1, p = 0.038) compared to ST patients. Of the 13 unrelated tumors which were diagnosed among patients with MPN, 11 were diagnosed prior to the MPN diagnosis and included 5 breast cancers (2 treated surgically, 2 treated with surgery, radiation and chemotherapy, 1 treated with surgery and radiation only); 3 neural tumors including 1 meningioma, 1 pituitary macroadenoma, and 1 schwannoma (all treated with surgery alone); 2 hematologic malignancies including a low grade B-cell lymphoma and a rectal MALT lymphoma (1 treated with combination chemotherapy and 1 treated with Rituxan alone); and 1 prostate cancer (treated with hormonal therapy alone). Two patients developed unrelated tumors during the course of their MPN; these included 1 patient with gastrointestinal stromal tumor and 1 with multiple myeloma. Interestingly, the latter patient has maintained a normal platelet count without cytoreductive ET therapy for the 18 months since autologous transplant for his myeloma. Conclusions Patients with PV and ET have a significantly higher risk of having prior or concurrent tumors unrelated to progression of their MPN when compared to patients with ST. Disclosures: No relevant conflicts of interest to declare.
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Norman, Armando Henrique. "Medical ethics and screening: on what evidence should we support ourselves?" Revista Brasileira de Medicina de Família e Comunidade 9, no. 31 (May 4, 2014): 108–10. http://dx.doi.org/10.5712/rbmfc9(31)933.
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If screening had been a drug, it would have been withdrawn from the market. Thus, which country will be first to stop mammography screening? (Peter C. Gøtzsche) 1This issue of RBMFC addresses the subject of medical ethics, the backbone that should guide both the demands in health services and health technologies provision, as well as the practice of family and community physicians. As a stimulus for reflection, the Debate section tackles the “Preventive mandatory mammography” policy in Uruguay, while in the Section Essays, Jamoulle and Gomez discuss the concept of quaternary prevention: action that aims to offer ethically acceptable alternatives to patients in order to prevent the excess of medical interventions.2 Despite considerable technological and social transformations that directly affect people’s health, ethics in medicine continues to morally shape health problems and health policy decisions with implications for patients, physicians and health institutions.In a practical analytical and easy to understand guidance for health professionals, Gillon3 discusses the four principles and scope of medical ethics: autonomy, beneficence, non-maleficence and justice. The latter encompasses the distributive justice, individual right justice and legal justice. These four principles provide a baseline for dialogue across different cultures, religious beliefs and political positions, as these principles are considered to be prima facie: a duty which is compulsory on all occasions unless it is in conflict with equal or stronger duties.4 Thus, based on these four principles that underlie ethics in medicine and consequently the application of the quaternary prevention, cancer screening programme will be critically analysed as a preventative strategy.Screening programmes entails the use of an initial selective tool or a sieve phase (i.e. mammography) to separate asymptomatic persons within the target population, that will need to undergo a classificatory or diagnostic phase - which involves a ‘gold standard’ for defining a disease (i.e. anatomopathology) – to finally offer patients a definitive preventive treatment for the condition screened.5 Since this type of intervention is performed on healthy individuals, the ethical requirements in the cases of screening programmes are very high, because the risks of damage are not balanced against real suffering (a clinically manifested disease), but are anchored in a potential future of illness and death. In this case, the principle of non-maleficence (do not harm) prevails over the principle of beneficence (the desire to promote the patients’ wellbeing), since asymptomatic persons, who perceive themselves as healthy, may have their health perception shaken indefinitely due to a biomedical intervention. The most often cited damages in the literature are psychological (due to the uncertainties of false positives, false assurance of false negatives, and borderline conditions that require a closer monitoring such as Cervical Intraepithelial Neoplasia - CIN I, II, III), as well as the physical consequences resulting from treatment itself, such as impotence or urinary incontinence, in the case of screening and treatment of prostate cancer.Since in the screening and/or health check ups the intervention is usually a ‘mirage-guided’ or ‘probability-guided’, it can result in ‘damage without the potential benefits’,6 as in the case of invasive procedures (to clarify ‘images’ or ‘positive’ exam results produced in the selective or sieving phase) which can result in complications, but the biopsy turnout to be normal. For instance, colonoscopy, laparoscopy, biopsies (liver, kidney, prostate), in which those procedures may end up producing complications (intestinal perforation, anaesthesia complications, major artery perforation, sepsis) with the potential to scale up into hospital readmission, with stress for patients and families and/or an even worse scenario: patients’ death with a benign finding. Therefore, screening programmes intrinsically carry the potential to convert healthy people into sick individuals at the population level, and consequently are highly iatrogenic and could be summarized as follows: “For many are called, but few are chosen…,” but many will need to suffer for to very few be cured.This is particularly true in the case of breast cancer screening with mammography, which renders physiopathologically insignificant cancers (overdiagnosis) exposing previously healthy women to significant damages due to radiotherapy. Gotzsche et al.7 highlighted important risks of adverse effects as consequence of radiotherapy, such as heart failure (27%) from circulatory cardiac damage and/or induction of lung cancer (78%). Furthermore, a recently published systematic review in the British Medical Journal8 on the adverse effects of cancer screening, found that only a third of randomized controlled clinical trials was concerned in measuring and controlling for potential harms of screening intervention. This article is very important because it has a direct effect upon the practice of health professionals, who cannot address security parameters on cancer screening interventions with their patients, since there is an information selection bias that emphasizes only the positive aspects of screening, for lack of controlling and monitoring of potential harms in most screening clinical trials.From an ethical stance, this context of uncertainty undermines the patients’ autonomy, creating false empowerment, since women do not have a more complete view on the potential harms and benefits of breast cancer screening programmes.9 To truly empower women and strengthen their autonomy for deciding upon interventions that directly affect their health, there is a need for information to be more transparent and also to reveal potential harms of the interventions. Moreover, the language used for the dissemination of information should be neutral, of simple understanding, culturally accessible, so that the users of the health system can better decide about their own health.3From the perspective of public health, distributive ethic justice, and limited healthcare budget - that any health system faces - screening programmes diverts financial resources - which should primarily be allocated to the treatment and care of sick individuals - towards healthy people, with the potential to produce new real patients, due to the damage of the interventions on healthy bodies, generating more costs to the health system and society in general.Fortunately, screening programmes are increasingly losing their strength, especially in Europe. For instance, the Swiss Medical Board10 found no scientific rational for the maintenance of breast screening programmes in light of current available scientific evidence. In Denmark, the rate of mortality attributable to breast cancer have not reduced due to the implementation of systematic breast cancer screening programme with mammography over 17 years follow up,11 however, it has produced an overdiagnosis rate of 33%.12 Similar trends in mortality over the last 30 years were also observed in the United States,13 as well as in Canada, the accumulated 25 years monitoring of the effects of breast cancer screening, did not render reduction in mortality from breast cancer, but resulted in 22% of overdiagnosis.14 Thus, to Peter C. Gotzsche,1 one of the world ‘s leading authorities on the subject, the best method we have to reduce the occurrence of breast cancer is to stop screening with mammography.From an ethical and scientific point of view,10 screening programmes should be discontinued or restricted to high-risk groups or very specific situations, and the focus of prevention should be redirected towards interventions on early-symptomatic patients, since breast cancer treatment has improved considerably in recent decades, and this is likely to be the responsible for improving the quality of life of affected women.1 The Canadian Task Force15 on preventive health care in their last update (2011) regarded as weak recommendation the breast cancer screening with mammography every 2-3 years in age group 50-69 years-old, because they considered the evidence for screening only of moderate quality. The Brazilian Ministry of Health16 also acted correctly in limiting the financial incentives for breast cancer screening for the age group 50-69 years.Therefore, ‘there is nothing wrong saying no to mammography’,9 because when acting upon asymptomatic healthy people, the principle of non-maleficence should override the principle of beneficence. Thus, the challenge left for family and community doctors is to individualize each case in this ‘sea of uncertainty’, sharing with their patients the often hidden potential harms attributed to cancer screening in order to operationalize in daily practice the concept of quaternary prevention.
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Kayser, Sabine, Konstanze Doehner, Juergen Krauter, Heinz A. Horst, Marie von Lilienfeld-Toal, Ulrich Germing, Katharina Goetze, et al. "Treatment-Related AML Is An Independent Adverse Prognostic Factor for Relapse-Free and Overall Survival. An Analysis of 2,868 Adult Patients with Newly Diagnosed AML Enrolled On Seven AMLSG Treatment Trials." Blood 114, no. 22 (November 20, 2009): 578. http://dx.doi.org/10.1182/blood.v114.22.578.578.
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Abstract Abstract 578 Background: Therapy-related AML (t-AML) is a recognized clinical syndrome occurring as a complication following cytotoxic and/or radiation therapy. The etiology and specific factors that predispose to t-AML largely remain unknown. Survival of t-AML patients has been poor compared with that of patients with de novo AML. However, there is a paucity of studies evaluating the impact of t-AML as a risk factor, in particular in the context of other clinical and biological prognostic markers. Aims: To study the clinical impact of t-AML in a large cohort of patients with newly diagnosed AML, in the context of clinical characteristics as well as cytogenetics and mutational status of the NPM1 and FLT3 genes. Methods: The study included 3,139 adult patients (median age, 53.5 years; range, 16-85 years) with newly diagnosed AML entered on 7 protocols of the German-Austrian AML Study Group (AMLSG) between 1993 and 2008. In all protocols intensive induction and consolidation therapy was used. Information on type of AML, karyotype and molecular marker status of NPM1 and FLT3 (internal tandem duplication [ITD] and tyrosine kinase domain mutation [TKD]) was availabel in 2,858 of 3,139 (91%) and 2,126 of 3,139 (68%) patients, respectively. Since this report focuses on the comparison of t-AML versus de novo AML, patients with secondary AML following myelodysplastic syndrome (s-AML) and those lacking information on type of AML were excluded (n=151, n=120, respectively). Results: Two hundred of the 2,868 patients (7%) were classified as t-AML. In more than two thirds of t-AML cases, a solid cancer was the primary malignancy with breast cancer being the most common (55%), followed by gastrointestinal (7.5%), prostate (7%) and testicular cancer (7%). In 27% of the cases, a hematologic neoplasm was the primary malignancy with non-Hodgkin (43%) and Hodgkin lymphoma (35%) being the most common. Three patients received cytotoxic treatment for autoimmune diseases. The median latency period between diagnosis of primary malignancy and occurrence of t-AML was 4 years (range, 4 months to 44 years). Patients with t-AML were significantly older compared to patients with de novo AML (58 versus 53 years; p<0.0001), and they had significantly lower median white blood counts (WBC) (7.4 vs 12.5 ×109/L; p=0.002). The frequencies of cytogenetic risk groups in t-AML versus de novo AML were as follows: favorable [t(8;21), t(15;17), inv(16) or t(16;16)] (16% vs. 16%), intermediate [all cytogenetic abnormalities not classified as favorable or adverse] (46% vs. 66%), and adverse [t(v;11q23), inv(3) or t(3;3), t(9;22), -5 or 5q-, -7 or 7q-, abn(17p), complex karyotype] (38% vs. 18%, respectively). Response to induction therapy was not significantly different between t-AML (64%) and de novo AML (69%) in uni- (p=0.18) and multivariable (p=0.58) analysis. In contrast, for the clinical endpoints relapse-free (RFS) and overall survival (OS), t-AML was an adverse prognostic factor in univariable (p<0.00001, p<0.00001, respectively) and multivariable analyses (HR, 1.69, p=0.001; HR, 1.3, p=0.004, respectively). The negative prognostic impact of t-AML on RFS was due to both a higher cumulative incidence of relapse (p=0.01) and death in complete remission (CR) (p=0.0001). In cytogenetic subgroup analyses, t-AML was an unfavorable factor for OS in particular in patients with inv(16) or t(16;16) (p=0.008), whereas this was not the case in t(8;21) and t(15;17). In cytogentically normal AML, OS was significantly inferior in t-AML patients (p=0.009), and this negative impact was due to a significant inferior OS in the molecularly defined subgroups NPM1mut/FLT3-ITDneg (p=0.05) and the triple negative group (p=0.004), whereas there was no difference in the subgroup FLT3-ITD and CEBPAmut. In as treated analyses in patients younger than 61 years with t-AML, allogeneic hematopoietic stem cell transplantation (HSCT) in first CR had a beneficial effect in cytogenetic intermediate- and adverse-risk (OS, p=0.008), but not favorable-risk patients. Conclusions: In this large cohort of adult patients with newly diagnosed AML, t-AML was an independent adverse prognostic factor for RFS and OS. The negative impact on RFS was not only due to an increased relapse rate but also to a higher rate of deaths in CR, possibly reflecting cumulative toxicity of primary and secondary cancer therapy. Allogeneic HSCT appears to have a beneficial impact in younger adults with t-AML. Disclosures: No relevant conflicts of interest to declare.
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De Oliveira, Mariana Pires, Brunna De Souza Barni, Lucas Antonio Heinen Schuster, Daniel Guimarães Gerardi, Emerson Antonio Contesini, Marcelo Meller Alievi, and Saulo Petinati Paravirini. "Feline Prostatic Carcinoma." Acta Scientiae Veterinariae 47 (December 30, 2019). http://dx.doi.org/10.22456/1679-9216.98793.
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Background: Prostatic cancer is a rare condition in cats but should be included as a differential diagnosis whenever middle-aged cats present lower urinary tract signs, such as dysuria and hematuria. Abdominal ultrasound can indicate the disease, but fine-needle aspiration cytology and histopathology are necessary to establish the neoplastic origin and the therapeutic plan. Because of the limited data, no standard-of-care treatment or prognostic information exists in cats with prostate carcinoma. This report describes the clinical signs, diagnosis and surgical approach in a case of prostatic carcinoma in a cat. Case: A 6-year-old, intact male, domestic short-haired cat was presented with a 3-day history of dysuria, hematuria, inappetence, constipation, lethargy and prostration. On physical examination, the cat was in a very poor general condition and abdominal palpation revealed firm mass located caudally to the urinary bladder. The urinary bladder presented high repletion degree, while the large bowel was distended and presented soft faecal content. Blood count, serum biochemistry and urinalysis showed neutrophilic leukocytosis, hypoalbuminemia and high serum creatinine level, and severe hematuria, respectively. Abdominal ultrasound showed a mass located in the prostatic area with hypoechogenic and slightly heterogeneous parenchyma, measuring 3.3 x 3.0 cm. Echo-guided trans-abdominal fine-needle aspiration of the prostate was performed. Microscopically, the cells were round with basophilic cytoplasm, and had round to ovoid nuclei, dense chromatin and prominent nucleoli. Some cells were binucleated and mild anisocytosis and marked anisokaryosis were documented. These findings were compatible with malignant prostatic neoplasia. After initial clinical stabilization, the patient underwent an exploratory laparotomy for tumor resection. Cystotomy followed by pubic osteotomy was performed to access the tumor. Urethral anastomosis was necessary due to adherence of the neoplasm to adjacent structures. However, the patient died during the immediate postoperative period. No complications related to surgery were observed at necropsy. Tissue specimens were collected and stained by hematoxylin and eosin. Prostatic carcinoma was confirmed by immunohistochemistry tests using streptavidin-biotin-peroxidase complex method, and primary antibodies against vimentin, cytokeratin AE1/AE3 and 7. Discussion: Prostatic neoplams are rare in cats and clinical signs are suggestive of lower urinary tract disease, such as dysuria and/or hematuria, associated with tenesmus. Abdominal or rectal palpation seems to be essential to detect the prostatic enlargement. Ultrasound imaging was more sensitive than radiography, since it brings more information about structure, size, form and prostatic internal architecture. The patient’s serum creatinine value above the normal range for cats indicated partial urethral obstruction, due to neoplastic concentric growth. Echo-guided trans-abdominal fine needle aspiration cytology was an effective method to confirm neoplastic etiology. The advanced stage of the disease and poor clinical condition probably contributed to death at the immediate postoperative period, even though the surgical technique seemed to be appropriate as demonstrated at necropsy. Also, the immunohistochemistry tests allowed to confirm the diagnosis and excluded the main differential diagnoses, such as urothelial carcinoma and prostatic sarcomatoid carcinoma.
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Queiroz, Marcos RG, Priscila M. Falsarella, Leonardo G. Moreira Valle, Guilherme Cayres Mariotti, Gustavo C. Lemos, Wladimir Alfer Junior, and Rodrigo G. Garcia. "Is a sampling transition zone important to increase the detection of prostate cancer in systematic prostatic biopsies?" Acta Radiologica, July 6, 2020, 028418512093836. http://dx.doi.org/10.1177/0284185120938363.
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Background Use of transrectal ultrasound (US)-guided biopsies improved diagnosis and treatment for patients with high prostate-specific antigen (PSA) or abnormal digital rectal exam (DRE). Purpose To investigate whether taking two transition zone (TZ) biopsies in addition to routine prostate double-sextant biopsies (12-cores) would improve detection rates of prostate cancer (PCa). Material and Methods A retrospective analysis of 1107 in a single institution database after Institutional Review Board approval, which underwent US-guided prostate biopsies from January 2014 to June 2016. All patients with suspected PCa based on positive DRE or high PSA submitted to US-guided prostate biopsy (double-sextant 12-cores alone and 12-cores with two TZ extra cores) were included. Results A total of 1107 patients were included; 120 patients underwent double-sextant 12-cores alone and 987 underwent 12-cores with two TZ extra cores. Among patients submitted to two TZ extra cores, TZs of 755 (76.5%) patients were negative to neoplasia and 232 (23.5%) were positive to neoplasia. Among these patients, 26 (2.6%) had their final Gleason score increased with TZ core; TZ fragments of 20 (2.0%) patients led to a treatment change (re biopsy, active surveillance or from active surveillance to radiation therapy or radical prostatectomy). When the complication rate is analyzed (with or without hospital admission), among the patients submitted to TZ cores, 259 (26.2%) complications were observed; between those submitted to double-sextant 12-cores, 26 (21.7%) complications were observed ( P=0.279). Conclusion Extended core biopsy protocol with two TZ extra fragments improves detection rates of cancer when compared to double-sextant biopsy protocol without increasing complication rates. TZ routine cores should be considered.
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Wilk, Michał, Anna Waśko-Grabowska, and Sebastian Szmit. "Cardiovascular Complications of Prostate Cancer Treatment." Frontiers in Pharmacology 11 (December 22, 2020). http://dx.doi.org/10.3389/fphar.2020.555475.
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Treatment of prostate cancer (PC) is a rapidly evolving field of pharmacology research. In recent years, numerous novel therapeutics that improve survival and ameliorate disease control have been approved. Currently, the systemic treatment for prostate neoplasm consists of hormonal therapy, chemotherapy, immunotherapy, radiopharmaceuticals, targeted therapy, and supportive agents (e.g., related to bone health). Unfortunately, many of them carry a risk of cardiovascular complications, which occasionally pose a higher mortality threat than cancer itself. This article provides a unique and comprehensive overview of the prevalence and possible mechanisms of cardiovascular toxicities of all PC therapies, including state-of-the-art antineoplastic agents. Additionally, this article summarizes available recommendations regarding screening and prevention of the most common cardiac complications among patients with advanced cancer disease.
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G.E., Roitberg, Dorosh J.V., Tarasova T.V., Saushev I.V., Shuligina I.V., Mosina L.M., and Khaidar D.A. "ADJUVANT CHEMOTHERAPY IN THE TREATMENT OF PATIENTS WITH GALLBLADDER CANCER." "Medical & pharmaceutical journal "Pulse", May 20, 2021, 127–35. http://dx.doi.org/10.26787/nydha-2686-6838-2021-23-5-127-135.
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Among the malignant neoplasms of the hepatobiliary zone, gallbladder cancer (GBC) is rare. The incidence of GBC is highest in patients over 65 years of age. In the early stages GBC rarely has clinical manifestations, and often occurs under the guise of other gastroenterological diseases, and is often an accidental finding. Since GBC tends to show high dissemination, at the time of diagnosis, almost every second patient has an advanced form of the disease that is not the subject to surgical treatment. Most authors tend to believe that the use of combined treatment of GBC (extended resection and adjuvant chemotherapy) significantly increases the survival rate of patients. Currently, about 1/3 of patients receive adjuvant chemotherapy in the treatment of GBC. This is due to a small number of prospective randomized trials. Today, most experts recognize that surgery is the only treatment that can be performed in patients with early stages of prostate cancer. At the same time, a reduction in the risk of complications and a large percentage of five- and ten-year survival are achieved. Traditional cholecystectomy can be used to treat stage 1a PCa, this is possible if PC is accidentally found during surgical treatment of GSD. Unfortunately, prostate cancer and bile ducts belongs to the group of malignant neoplasms, in which most patients are unable to perform radical surgical treatment due to for the rapid dissemination of the process. When determining the tactics of patient supervision, it is necessary to take into account the prognostic factors of overall survival in prostate cancer: the type of surgery, the patient's age and sex, the size of the tumor, the presence of metastases in the regional lymph nodes, the presence of adjuvant chemotherapy. There is still a dispute between specialists about the appointment of adjuvanted chemotherapy to patients after surgical treatment of prostate cancer. Many authors acknowledge that adjuvant chemotherapy plays a positive role in improving patient survival after surgery. RAD is recognized as a chemosensitive cancer. Several drugs are active in relation to RS, used for adjuvant chemotherapy: fluorouracil, gemcitabine, mitomycin, cisplatin, capecitabine, epirubicin, and oxaliplatin. This article provides an overview of current research that is aimed at studying the effectiveness of adjuvant chemotherapy in patients with verified GBC of various stages.
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Sung, Joseph J. Y., Arthur K. C. Luk, Simon S. M. Ng, Anthony C. F. Ng, Peter K. F. Chiu, Emily Y. Y. Chan, Polly S. Y. Cheung, et al. "Effectiveness of One-Stop Screening for Colorectal, Breast, and Prostate Cancers: A Population-Based Feasibility Study." Frontiers in Oncology 11 (February 25, 2021). http://dx.doi.org/10.3389/fonc.2021.631666.
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Colorectal cancer (CRC), prostate cancer (PC) and breast cancer (BC) are among the most common cancers worldwide with well-established screening strategies. We aim to investigate the effectiveness and compliance of a one-stop screening service for CRC, PC and BC. Asymptomatic subjects aged 50–75 years were invited. Eligible subjects were offered fecal immunochemical test (FIT) for CRC screening. Serum prostate specific antigen (PSA) and Prostate Health Index (PHI) were offered for male PC screening and mammogram (MMG) for female BC screening as a one-stop service. Colonoscopy was offered to FIT+ subjects, prostate biopsy to PSA/PHI+ (PSA>10/PHI≥35) males and breast biopsy to MMG+ (Breast Imaging-Reporting and Data System, BI-RADS≥4) females. From August 2018 to April 2020, 3165 subjects were recruited. All participants (1372 men and 1793 women) were willing to accept FIT for CRC screening, and PSA/PHI test or MMG as second cancer screening. 102 subjects diagnosed advanced neoplasms after colonoscopy. Thirty-three males diagnosed PC after prostate biopsy and 15 females diagnosed BC after breast biopsy. No major complication reported in first tier screening tests. Subjects who were willing to undergo CRC screening were highly likely to accept other cancer screening when offered in a one-stop program. In conclusion, the effectiveness and compliance of a one-stop service for CRC, PC, and BC screening among asymptomatic subjects were high. Future studies should be conducted to test various ways of integrating cancer screening programs.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT04034953.
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Francis-Emmanuel, Patrice, Rana Siddique, Elaine Soong, John Clark, Joohi Majeed, Nishan Wijenaike, Haris Marath, Anupam Brahma, and Rahat Tauni. "SAT-148 Ectopic ACTH Secretion Has Varied Presentation and Requires Individualized Treatment - One Size Does Not Fit All." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.1725.
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Abstract Ectopic ACTH secretion (EAS) presents in myriad ways. We present five cases of EAS to highlight similarities and differences in presentation and treatment. The first woman with known metastatic lung neuroendocrine tumour (NET) for two years presented with facial fullness, proximal weakness, worsening hypertension and hypokalaemia. Random cortisol of 2742nmol/L (99.39mcg/dL), with adrenocorticotrophic hormone (ACTH) of 201ng/L (5-50), was in keeping with EAS. She received medical treatment followed by bilateral adrenalectomy with EAS resolution and development of adrenal insufficiency. She is doing well. The second woman with proximal weakness was evaluated by neurologists. All neurological tests were normal but facial fullness and easy bruising was noted. Random cortisol was 875nmol/L (31.71mcg/dL) and ACTH was 90 ng/L. Imaging revealed metastatic liver disease with unknown primary and biopsy confirmed NET. Cortisol rose despite medical treatment and she died within fifteen months. The third woman with significant smoking history presented with haemoptysis and breathlessness. A right lung mass was suspected on chest X-ray and confirmed with CT. Endobronchial ultrasound-guided biopsy revealed small cell lung cancer (SCLC). She developed generalised weakness and severe hypokalaemia. Random cortisol of 1645nmol/L (59.63mcg/dL) with ACTH of 282ng/L suggested EAS. Despite medical treatment, she died within two weeks. The fourth woman presented with confusion, hypertension and severe hypokalaemia. Morning cortisol of 8557nmol/L (310.19mcg/dL) and random ACTH of 73ng/L were suggestive of EAS. CT demonstrated left lung mass with widespread metastases. She deteriorated and died within 2 weeks. Our only man had incidentally discovered metastatic liver lesions on ultrasound. Further imaging revealed prostatic mass and biopsy showed small cell neuroendocrine cancer. He presented with severe hypokalaemia. Random cortisol was 1065nmol/L (38.61mcg/dL) and ACTH was 188ng/L. He was commenced on medical treatment but declined rapidly and died. All our patients had profound hypokalaemia and metastatic disease at presentation. Many patients do not exhibit classical cushingoid features as EAS tends to develop acutely and underlying malignancy drives weight loss. A high index of suspicion is required to make a diagnosis. EAS should be considered in patients with proximal myopathy, pigmentation, resistant or severe hypokalaemia or hypertension and known or suspected malignancy. Early and quick control of cortisol excess is essential to minimise cardiometabolic abnormalities, severe infections and thromboembolic complications. Prognosis depends upon age, frailty, comorbidity, nature of neoplasm and extent of hypercortisolaemia. Adrenolytics with or without bilateral adrenalectomy, reduction in tumour burden and management of complications are the mainstay of treatment.
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Breik, Nessrine, Mouna Jerbi, Raja Aoudia, Soumaya Chargui, Hanen Guaied, Imen Gorsane, Rim Goucha, and Taieb Benabdallah. "P0314TREATMENT AND OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY PATIENTS." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa142.p0314.
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Abstract Background and Aims The increase in life expectancy has led to increasing numbers of elderly patients in all medical disciplines, particularly in nephrology. Idiopathic membranous nephropathy (IMN) is common in the elderly and can lead to significant morbidity and mortality because of the complication of nephrotic syndrome (NS) and immunosuppressive therapy. The aim of this study is to analyze the diagnostic, therapeutic and evolutionary approach of IMN in elderly patiets. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery were dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (39.28%) and elevated creatinine level in 9 cases (32.14%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone (group 1), three patients received corticosteroid with mycofenolate mofetil (group 2) and one patient received corticosteroid with ciclosporin (group3). Fourteen patients received only symptomatic treatment (group 4). We noted partial remission in group 3, however complete remission in 37.5%, 14.28% and 12.5% from respectively group 1, group 4 and group 2. The side effects of immunosuppressive therapy were infectious complication in 8 patients (28.5%), osteoporosis in 3 patients (10.7%) and Steroid diabetes in one case. The side effects of NS were thrombotic complication in 5 patients (17.85%). Two patients had presented coronary syndrome and two other patients had presented hepatitis C. Two cases of death were noted whose etiology was pulmonary infection in one patient and undeterminate etiology in the other case. Conclusion Treatment of IMN in older patients has unique challenges, reducing the need for renal replacement therapy. Most studies report that the elderly respond to therapy with rates comparable with younger patients but in the other hand elderly are more susceptible to side effects of immunosuppressive therapy.