三维适形放疗联合多西紫杉醇同期化疗治疗老年局部晚期非小细胞肺癌临床研究

目的:研究三维适形放射治疗联合多西紫杉醇同期化疗治疗老年局部晚期非小细胞肺癌疗效和不良反应.方法:84例局部晚期非小细胞肺癌患者随机分成A组和B组,A组40例采用三维适形放射治疗,总剂量66-70Gy/33-35次,6-7周完成.B组44例采用三维适形放射治疗联合多西紫杉醇同期化疗.结果:两组患者的总有效率分别为57.9%和80.5%,其中CR率分别为7.9%和29.3%,P＜0.05.两组1、2年生存率分别65.7% vs 80.5%和 39.5% vs 53.7%( P＞0.05).A组患者中位生存期为10.5个月,B组患者为19.5个月.两组患者早期放射反应主要为I-II级放射性食道炎和骨髓抑制,后期放射反应主要为I-II级放射性肺炎,发生率两组接近.结论:三维适形放射治疗联合多西紫杉醇同期化疗治疗局部晚期非小细胞肺癌疗效优于单纯三维适形放射治疗.     

三维适形放射治疗局部晚期非小细胞肺癌的临床研究

目的研究常规放疗与三维适形放疗结合治疗局部晚期非小细胞肺癌的疗效和放射反应。方法自2003年6月至2005年1月,66例局部晚期非小细胞肺癌患者随机分为A组和B组A组采用常规放射治疗,总剂量为60Gy/30次,6~7周完成;B组常规放疗40Gy后采用三维适形放射治疗24~30Gy/10~12次,每次240~300cGy,6~6.4周完成。结果A、B两组患者总有效率分别为60.0%和80.6%(P>0.05);完全缓解率分别为8.6%和32.3%(P<0.05);两组1年生存率分别为65.7%和77.4%(P>0.05);两组放射反应主要为Ⅰ~Ⅱ级急性放射性食管炎。结论局部晚期非小细胞肺癌常规放疗后采用三维适形放疗加量照射,患者可耐受,可提高肿瘤控制率,延长患者生存期。     

应用立体定向适形放射治疗技术治疗胰腺癌的时间剂量分割模式探讨

目的:探讨应用立体定向适形放射治疗技术治疗胰腺癌的最佳时间剂量分割模式。方法:58例不能手术治疗的局部晚期胰腺癌患者分为常规放疗组(28例)和非常规放疗组(30例),分别接受常规剂量常规分割和非常规剂量常规或低分割立体定向适形放射治疗,等效生物剂量均为55Gy左右。放疗结束后应用5-FU化疗2~4周期。按世界卫生组织(WHO)制定的肿瘤客观疗效评价标准对两组患者近期疗效进行观察比较;按美国放射肿瘤学会协作组(RTOG)制定的早期放射损伤分级标准对两组患者急性放射反应进行观察比较;对两组患者中位生存期、临床受益反应进行观察对比。结果:常规放疗组和非常规放疗组患者治疗结束后3个月疗效分别为42·86%和50·00%(P>0·05);常规放疗组和非常规放疗组患者中位生存期分别为13个月和12个月(P>0·05);临床受益反应率分别为64·29%和36·67%(P<0·05)。3级以上急性放射损伤主要为消化道反应和骨髓抑制,常规放疗组和非常规放疗组发生率分别为7·14%、7·14%和33·33%、40·00%,两组间比较差异显著(P<0·05)。结论:应用立体定向适形放射治疗技术常规剂量常规分割治疗胰腺癌急性放射反应轻,能够有效改善患者的生存质量,是一种合理的治疗模式。     

三维适形低分割放射治疗胸部肿瘤的疗效观察

目的观察胸部肿瘤应用三维适形低分割放射治疗的近期疗效和早期放射损伤。方法35例胸部肿瘤病人(包括非小细胞肺癌13例、食管癌、纵隔淋巴结转移癌各8例、肺转移癌6例)采用三维适形低分割放射治疗,单次剂量250~400 cGy(中位剂量300 cGy),5次/周,总剂量40~57Gy(中位剂量52Gy)。结果完全缓解(CR)16例,部分缓解(PR)13例,稳定(SD)6例,总有效率82.9%。严重的早期放射损伤为放射性肺炎Ⅱ级6例,Ⅲ级5例;放射性食管炎Ⅱ级8例,Ⅲ级8例,Ⅳ级1例。结论三维适形低分割放射治疗胸部肿瘤效果较好,但要注意肺部、食管单次剂量及受照射体积的耐受量,否则易引起严重的放射损伤。     

不同剂量分割模式的三维适形放疗对局部进展期胰腺癌的疗效分析

目的探讨局部进展期胰腺癌三维适形放疗最佳时间剂量分割模式。方法30例进展期胰腺癌患者随机分为两组,常规组15例,接受常规剂量分割(1.8~2 Gy/次,5次/周),低分割组15例,剂量分割(3~5 Gy/次,3~5次/周)。两组患者等效生物剂量相同(56 Gy)。结果常规组和低分割组有效率分别为46.7%和53.3%,1年生存率分别为20.0%和26.7%,差异无显著性。常规组和低分割组临床受益反应率分别为86.6%和53.3%,两组比较差异有显著性(P<0.05)。常规组疼痛缓解率86.6%,低分割组60.0%(P>0.05)。结论常规剂量分割的三维适形放疗治疗局部进展期胰腺癌急性放射反应轻,能有效改善临床症状,提高生活质量,延长生存期。     

适形调强放疗联合化疗治疗中晚期非小细胞肺癌72例

目的:评价三维适形调强放疗联合化疗在治疗中、晚期非小细胞肺癌(NSCLC)的作用。方法:72例中、晚期NSCLC患者采用分组治疗。A组采用常规放疗加化疗,共30例;B组采用三维适形放疗加化疗,共30例;C组采用三维适形调强放疗加化疗,共12例。三组均采用铂类联合盖诺方案化疗1个周期后放疗,放疗结束后再化疗3~5个周期。结果:A组有效率(CR PR)43·3%,B组有效率70%·0,C组有效率83·3%,A组与B组,A组与C组差异有统计学意义,P<0·05;1年生存率:A组40·0%(8/20),B组为66·7%(12/18),C组为100·0%(4/4)。B、C组合并后的1年生存率与A组差异有统计学意义,P=0·03;三组的骨髓抑制等基本相同;放射性食管炎,三组间差异无统计学意义,P=0·16。急性放射性肺炎:A组56·7%,B组33·3%;C组16·7%。A组与C组差异有统计学意义,P=0·031。结论:在中、晚期NSCLC的治疗中,三维适形或调强放疗联合化疗与与常规放疗联合化疗相比,具有疗效好、毒副反应轻、患者容易耐受等特点;适形调强放疗在不增加放疗不良反应的同时,能够提高1年生存率和靶区的照射剂量。     

食管癌三维适形放疗分割方式研究

[目的]探讨食管癌三维适形放疗三种时间—剂量分割方式的疗效及副反应。[方法]选择未经治疗的食管癌患者169例,随机分为A（2Gy/次,5次/周,共30～33次）、B（2.5Gy/次,5次/周,共21～23次）和C（3.0Gy/次,5次/周,共16～18次）组,总剂量DT60～66Gy,中位剂量64Gy。[结果]近期有效率A组、B组和C组相似（95%、96%、95%,χ2=2.33,P=0.350）;完全缓解率三组亦无显著差异（75%、80%、77%,χ2=0.91,P=0.630）。3年生存率B组最高（36%、57%、39%,χ2=6.13,P=0.047）;3年局部控制率B组亦较高（36%、57%、51%,χ2=5.42,P=0.067）。早期2、3级放射性食管炎（27%、36%、52%,χ2=7.01,P=0.030,4%、9%、21%,χ2=7.60,P=0.023）和放射性肺炎（16%、27%、37%,χ2=6.23,P=0.041,0、4%、9%,χ2=5.54,P=0.064）发生率C组最高;晚期2、3级放射性食管炎C组最高（13%、18%、32%,χ2=6.68,P=0.037;4%、9%、18%,χ2=6.25,P=0.040）;3级晚期放射性肺炎发生率C组亦最高（0、5%、11%,χ2=6.21,P=0.041）。[结论]常规2.5Gy/次,5次/周分割方式比常规分割治疗效果好,副反应可接受,可考虑作为三维适形放疗食管癌的治疗模式。     

三维适形放疗联合动脉灌注化疗治疗局部晚期胰腺癌的临床疗效观察

目的 评价三维适形放射治疗结合动脉灌注化疗局部晚期胰腺癌的疗效.方法 59例局部晚期胰腺癌患者,其中33例采用三维适形放射治疗结合动脉灌注化疗(综合治疗组),26例单纯放疗组(对照组).结果 综合治疗组和对照组临庆获益反应有效率分别为91.7%和74.1%,两者差异有统计学意义(P<0.01);综合治疗组总有效率(CR+PR)为78.8%,对照组总有效(CR+PR)为42.3%,两组差异有统计学意义(P<0.01);综合治疗组和对照组的1、2和3年生存率分别为72.2%、48.5%、9.1%和50.0%、15.4%、3.9%,2年生存率综合组优于对照组(P<0.01).结论 三维适形放射治疗结合动脉灌注化疗治疗局部晚期胰腺癌,在提高生存率、长生存期方面优于单纯放射治疗.     

三维适形放疗联合多西紫杉醇同期化疗治疗老年局部晚期非小细胞肺癌临床研究

目的：研究三维适形放射治疗联合多西紫杉醇同期化疗治疗老年局部晚期非小细胞肺癌疗效和不良反应。方法：84例局部晚期非小细胞肺癌患者随机分成A组和B组,A组40例采用三维适形放射治疗,总剂量66—70Gy／33—35次,6—7周完成。B组44例采用三维适形放射治疗联合多西紫杉醇同期化疗。结果：两组患者的总有效率分别为57．9％和80．5％,其中CR率分别为7．9％和29．3％,P〈0．05。两组1、2年生存率分别65．7％vs80．5％和39．5％vs53．7％（P〉0．05）。A组患者中位生存期为10．5个月,B组患者为19．5个月。两组患者早期放射反应主要为Ⅰ—Ⅱ级放射性食道炎和骨髓抑制,后期放射反应主要为Ⅰ-Ⅱ级放射性肺炎,发生率两组接近。结论：三维适形放射治疗联合多西紫杉醇同期化疗治疗局部晚期非小细胞肺癌疗效优于单纯三维适形放射治疗。     

腔内放射治疗食管癌疗效分析

目的　食管癌腔内放射治疗与单纯外照射的疗效分析 ,探讨食管癌腔内高剂量率、时间、剂量、分割因素 ,提高局部控制率和生存率。方法　对 2 0 0例食管癌患者随机分为腔内加体外照射A、B两组 ,各 6 0例 ,单纯外照射C组 80例 ,治疗方法 :A组先腔内 70 0cGy× 3次 / 3周 ,后外照 5 0Gy/ 5周。B组外照射 6 0Gy/ 6 2周 ,40Gy后加腔内 5 0 0cGy× 2次同时进行。C组单纯外照射 70Gy/ 7周。结果　 1、3、5年生存率A组为 46 7%、2 1 7%、6 7%,B组 73 3%、38 3%、2 1 7%,C组 5 6 3%、2 6 3%、16 3%,1年生存率B组高于A、C两组 ,有显著差异 (P <0 0 5 )。结论　A组放射反应重 ,疗效差 ,不易采用。B组较为理想 ,远期疗效有所提高 ,是腔内加体外照射目前可行的一种治疗方法。     

The medically important dematiaceous fungi and their identification

Dematiaceous fungi include a large group of organisms that are darkly pigmented (dark brown, olivaceous, or black). In most cases the pigment is melanin, and specifically, dihydroxynaphthalene melanin. The diseases produced include chromoblastomycosis, eumycotic mycetoma, and phaeohyphomycosis. Phaeohyphomycosis is a new classification for a diverse group of previously known entities grouped together on the basis of finding dematiaceous hyphal and/or yeast-like forms in tissue; tissue involvement may be superficial, cutaneous and corneal, subcutaneous, or systemic. Identification of these fungi is based mostly upon morphology. Important structures include annellides (Phaeoannellomyces, Exophiala), phialides (Phialophora, Wangiella), adelophialides (Phialemonium without collarettes, Lecythophora with collarettes), differentiation of conidiophores (Xylohypha versus Cladosporium) and conidial hilum, septation and germination (Bipolaris, Drechslera, Exserohilum). Useful laboratory tests include the 12% gelatin test (controversial), nitrate assimilation (W. dermatitidis is negative, most other species are positive), and determination of temperature maxima (especially 37 degrees C for E. jeanselmei, 40 degrees C for W. dermatitidis and B. spicifera, 42 degrees C for X. bantiana, and 45 degrees C for Dactylaria constricta var. gallopava and Scedosporium inflatum).     

Laboratory Techniques Alternative to In Vivo Experiments for Studying the Liberation, Penetration and Fungicidal Action of Topical Antimycotic Agents in the Skin, Including Ciclopiroxolamine

Summary: Short-term experiments on excised skin (human, pig) gave the following results: 1. In the tissue activity test with direct inoculation (D-TAT) commercial preparations of the non-azole antimycotics ciclopiroxolamine, tolnaftate and naftifine, produced higher inhibitory activity against Trichophyton mentagrophytes (standard strain) in various levels of the horny layer than were produced by the azole antimycotics econazole, miconazole, clotrimazole, oxiconazole and bifonazole. Fast drying solutions of antimycotics invariably gave higher inhibitory activities than creams. In the ultrafiltration tissue activity test (UFT- TAT) against Candida albicans (2 strains), antimycotic agents ranked in order of effectiveness as follows: ciclopiroxolamine – most of the azole antimycotics – bifonazole and naftifine. 2. In tests of fungicidal activity against T. mentagrophytes (2 strains) and Microsporum gypseum (1 strain) the first step was to inoculate the skin surface. After the horny layer had been penetrated by fungal mycelia, antimycotic agents of documented fungicidal potency, chiefly in the form of creams, were applied to the skin surface and left to act for up to 18 hours. The horny layer and epidermis were then scraped off and the concentration of viable fungi was determined. Ciclopiroxolamine cream and lotion produced by far the greatest diminution in viable fungi; creams containing oxiconazole and naftifine were moderately effective and those containing tioconazole and bifonazole produced a relatively small decrease in viable fungi. To avoid erroneous results it is important to homogenize and dilute the skin scrapings; if this is not done certain antimycotics will give misleadingly high fungal killing rates. At this early stage the scatter of results is still wide and minor differences in efficacy cannot as yet be detected with certainty. 3. From the results of various comparative tests it is evident that pig skin can be used as a substitute for human skin in the tests listed under 1. and 2. above. This discovery may make a valuable contribution towards limiting the need for experiments on living animals and trials on human beings. Zusammenfassung: In Kurzzeitversuchen an exzidierter Haut (Mensch, Schwein) wurde gefunden: 1. Im Gewebeaktivitätstest mit direkter Inokulation (D-GAT) wurde mit Handelspräparaten der Nichtazol-Antimykotika Ciclopiroxolamin, Tolnaftat und Naftifin in verschiedenen Hornschichtniveaus eine höhere Hemmaktivität gegenüber Trichophyton mentagrophytes (Standard-Stamm) erzielt als mit solchen der Azol-Antimykotika Econazol, Miconazol, Clotrimazol, Oxiconazol und Bifonazol. Rasch trocknende Lösungen von Antimykotika ergaben durchweg höhere Hemmaktivitäten als Cremes. Im Ultrafiltrations-Gewebeaktivitätstest (UFT-GAT) gegenüber Candida albicans (2 Stämme) ergab sich nach erzielter Wirksamkeit die Rangfolge Ciclopiroxolamine – Mehrzahl der Azolantimykotika – Bifonazol und Naftifin. 2. In Fungizidie-Testen gegenüber T. mentagrophytes (2 Stämme) und Microsporum gypseum (1 Stamm) wurde zunächst die Hautoberfläche inokuliert. Nach Durchdringung der Hornschicht mit Pilzmyzelien wirkten auf die Hautoberfläche bis zu 18 Stunden lang überwiegend Cremes von als fungizid publizierten Antimykotika ein. Während sich in abgeschabter Hornschicht und Epidermis der so bearbeiteten Hautoberflächen mit Ciclopiroxolamin-Creme und -Lotion die weitaus höchste Verminderung lebensfähiger Keime ergab, bewirkten Cremes mit Oxiconazol und Naftifin eine mittlere und solche mit Tioconazol und Bifonazol eine relativ niedrige Keimeliminierung. Zur Vermeidung von fehlerhaften Ergebuissen mußten Homogenisierung und Verdünnung der Hautschabsel erfolgen, anderenfalls bei mehreren Antimykotika eine zu hohe Keimabtötung vorgetäuscht worden wäre. Wegen der vorerst noch hohen Streuung der Ergebnisse können kleinere Wirksamkeitsunterschiede noch nicht sicher erfaßt werden. 3. Nach dem Ergebnis verschiedener Vergleichstests kann in den Testen zu 1. und 2. Schweinehaut als Ersatz für Haut vom Menschen dienen und dürfte damit wesentlich zur Einschränkung von Versuchen am lebenden Tier und von Prüfungen am Menschen beitragen.     

Efficiency of crude and purified fungal antigens in serodiagnosis to discriminate mycotic from other respiratory diseases

Mycotic immunodiagnosis was performed in 186 hospitalized patients with different respiratory diseases, mostly considered as tuberculosis and others with a doubtful diagnosis. Crude histoplasmin, coccidioidin, paracoccidioidin, blastomycin, candidin, aspergillin, and sporotrichin, as well as purified polysaccharide-protein complexes (PPC) of Histoplasma capsulatum, Coccidioides immitis, and Paracoccidioides brasiliensis were used as antigens. Immune tests used included skin test (ST), gel immunodiffusion (ID), counterimmunoelectrophoresis (CIE), complement fixation (CF), and ELISA. A possible association with candidosis was observed in 17% of patients with tuberculosis and diabetes; one presumptive paracoccidioidomycosis, one confirmed aspergillosis, and six cases of active histoplasmosis were determined. Candidin ST showed 29% of positive reactions with an increased frequency in patients between 31 and 55 years of age. CF test showed the highest positivity percentages with crude antigens, specially for Candida antigen (26.3%) and histoplasmin (18.2%). Cross reactions were evident with crude antigens but decreased when PPC's were used in ELISA.     

Isoconazole nitrate in the treatment of tropical dermatomycoses

Summary. A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum , two with candidoses of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (Travogen^R, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3–4 weeks. In 15 (31%) of the remaining patients treatment was required for 5–6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.
Zusammenfassung. Insgesamt 54 Patienten mit kulturell gesicherter Dermatomykose, (23 unterschiedliche Dermatophytosen, eine Trichosporon beigelii - und eine Geotrichum candidum -Fußinfektion, 2 Candidosen der Leistengegend und 27 Pityriasis versicolor) wurden in einer klinischen Wirksamkeits-studie mit 1% iger Isoconazol-Creme (Travogen^R, Schering, Berlin, Deutschland) behandelt. Fünf Patienten waren nicht auswertbar. Eine klinische und mykologische Heilung wurde bei 47 von 49 Patienten (96%) erreicht. Bei 29 patienten (59%) wurde die Heilung bereits nach 3–4 Wochen Behandlung erreicht. Weitere 15 Patienten (31%) benötigten 5–6 Wochen und drei Patienten 8 Wochen Behandlungsdauer. Zwei Mykosesituationen erwiesen sich als therapieresistent.     

Orale Langzeitbehandlung von Onychomykosen mit Ketoconazol

Zusammenfassung: An der Studie zur Wirksamkeit und Anwendungssicherheit von Ketoconazol nahmen 27 Männer im Alter von 20 bis 80 (Median: 57) Jahre, davon 18 mit Onychomykosen und 9 als KontroUen bei den Laborwertbestimmungen, teil. Während des ersten Behandlungsmonats erhielten je 9 Patienten 200 mg und 400 mg Ketoconazol täglich. Danach wurden beide Gruppen 6 Monate mit 200 mg/d weiterbehandelt. Die klinische Beurteilung sowie hämatologische, biochemische und Plasmaspiegeluntersu-chungen erfolgten mindestens monafich, mykologische Untersuchungen wurden vor Aufnahme und bei Beendigung der Therapie vorgenommen. Erne letzte klinische Unter-suchung erfolgte 1 Jahr nach Beginn der Studie. Nach 7 Monaten Behandlung wurden 23 von 30 Nägeln mit “gebessert” bis “stark gebessert” beurteilt, nach dem behandlungsfreien Intervall galt dies für 28 von 30 Nägeln. Die Plasmaspiegel waren mit 200 mg/d ausreichend und uber den Behandlungszeit-raum konstant. Dies spricht für gute orale Resorption und Abwesenheit von Enzyminduktion. Die Laborwerte zeigten im Vergleich zu den Kontrollen und den Werten vor Behandlung keine signifikanten Abweichungen, so daß myelo-, nephro- und hepatotoxische Wirkungen von 400 bzw. 200 mg/d ausgeschlossen werden können. Der Lipidhaushalt wurde nicht beeinfluat und es trat unter Therapie als Folge der Ketoconazolwirkung lediglich Lanosterin im Serum auf. Nach Beendigung der Therapie ging der Lanosteringehalt schnell zurück. Damit erweist sich Ketoconazol in den angewandten Dosen als ein gut verträgliches und zur Langzeitbehandlung von Onychomykosen geeignetes Antimykotikum. Summary: Twenty-seven males with a median age of 57 (range: 20 to 80) years took part in this study on the efficacy and safety of ketoconazole. Eighteen men suffered from onychomycosis; nine served as controls in the safety evaluation. During the first month of treatment, nine patients received 200 mg and the nine other 400 mg ketoconazole daily. Then the treatment was uniformly continued with 200 mg/d for 6 months. Clinical evaluation and haematological, biochemical and plasma level investigations were carried out at least at monthly intervals; mycological controls were performed at the start and end of therapy. A final clinical evaluation was carried out one year after the start of the study. After 7 months of treatment, moderate or definite clinical improvement was obtained in 23 out of 30 nails. After 5 more months without antimycotic treatment this was the case in 28 of 30 nails. Plasma levels obtained with 200 mg ketoconazole daily were adequate and constant during the entire treatment period. This indicates a good oral resorption as well as the absence of induction of hepatic enzymes. The laboratory values did not show significant deviations as compared with the controls or with the pretreatment values. This excludes myelo-, nephro- and hepatotoxic effects of 400 and 200 mg ketoconazole daily. The lipid metabolism was not influenced, the only difference was the occurrence of lanosterol in the serum, which is a result of the mechanism of action of ketoconazole. After the medication period the lanosterol levels subsided rapidly. In the applied doses ketoconazole is a well-tolerated and effective drug for the systemic long-term treatment of onychomycosis.     

Large-scale molecular characterization and analysis of gastric cancer

The recent effort by The Cancer Genome Atlas （TCGA） Network has revealed that gastric cancer, which is a leading cause of cancerrelated deaths worldwide with a 5-year survival rate less than 25%, is a much more heterogeneous disease than previously thought. And yet, conventional treatment approaches and clinical trials have assumed it is a single disease. Although it is well known that under the microscope, gastric cancer cells appear quite different, the current classification scheme recognizes two main categories of gastric cancer： diffuse and intestinal.     

A conceptually new treatment approach for relapsed glioblastoma: Coordinated undermining of survival paths with nine repurposed drugs (CUSP9) by the International Initiative for Accelerated Improvement of Glioblastoma Care

To improve prognosis in recurrent glioblastoma we developed a treatment protocol based on a combination of drugs not traditionally thought of as cytotoxic chemotherapy agents but that have a robust history of being well-tolerated and are already marketed and used for other non-cancer indications. Focus was on adding drugs which met these criteria: a) were pharmacologically well characterized, b) had low likelihood of adding to patient side effect burden, c) had evidence for interfering with a recognized, well-characterized growth promoting element of glioblastoma, and d) were coordinated, as an ensemble had reasonable likelihood of concerted activity against key biological features of glioblastoma growth. We found nine drugs meeting these criteria and propose adding them to continuous low dose temozolomide, a currently accepted treatment for relapsed glioblastoma, in patients with recurrent disease after primary treatment with the Stupp Protocol. The nine adjuvant drug regimen, Coordinated Undermining of Survival Paths, CUSP9, then are aprepitant, artesunate, auranofin, captopril, copper gluconate, disulfiram, ketoconazole, nelfinavir, sertraline, to be added to continuous low dose temozolomide. We discuss each drug in turn and the specific rationale for use- how each drug is expected to retard glioblastoma growth and undermine glioblastoma''s compensatory mechanisms engaged during temozolomide treatment. The risks of pharmacological interactions and why we believe this drug mix will increase both quality of life and overall survival are reviewed.     

Endometrial cancers and predisposition

As nearly 5% of all endometrial cancers occur because of a predisposition, this possibility has systematically to be explored. The hallmarks of predisposition, a young age at diagnosis, a personal or a familial history of cancer, have to be searched systematically. The identification of a predisposition in a family has a major impact on the management of the proband or his relatives. The endometrial cancer main predisposition is Lynch's syndrome. In this review, we will focus on this condition and describe its clinical manifestations, the underlying molecular mechanisms, the cancer risks and the management guidelines. We will also get onto some far less frequent other predispositions.