A prospective, controlled study of the botanical compound mixture LCS101 for chemotherapy-induced hematological complications in breast cancer

Background.

This prospective, controlled study evaluated the safety, tolerability, and efficacy of the mixture of botanical compounds known as LCS101 in preventing chemotherapy-induced hematological toxicity in breast cancer patients.

Methods.

Female patients diagnosed with localized breast cancer were randomly allocated to receive treatment with either LCS101 or placebo capsules, in addition to conventional chemotherapy. The study intervention was initiated 2 weeks prior to the initiation of chemotherapy and continued until chemotherapy was completed, with participants receiving 2 g of LCS101 capsules thrice daily. Subjects were assessed for the development of hematological and nonhematological toxicities, as well as the tolerability and safety of the study intervention.

Results.

Sixty-five breast cancer patients were recruited, with 34 allocated to LCS101 and 31 allocated to placebo treatment. Patients in the treatment group developed significantly less severe (grades 2–4) anemia (p < .01) and leukopenia (p < .03) when comparing grades 0–1 with grades 2–4, with significantly less neutropenia (p < .04) when comparing grades 0–2 with grades 3–4. This effect was more significant among patients undergoing a dose-dense regimen. No statistically significant effect was found with respect to nonhematological toxicities, and side effect rates were not significantly different between the groups, with no severe or life-threatening events observed in either group.

Conclusion.

The addition of LCS101 to anthracycline- and taxane-based chemotherapy is safe and well tolerated, and may significantly prevent some chemotherapy-induced hematological toxicities in early breast cancer patients. These results should encourage further larger and more extensive clinical trials.     

Predicting survival after radical cystectomy for bladder cancer

Accurate prediction is essential for patient counselling, appropriate selection of treatments and determination of eligibility for clinical trials. In this review we assess the available determinants of oncological outcome after radical cystectomy (RC) for transitional cell carcinoma of the urinary bladder. We reviewed previous publications to provide guidelines in terms of criteria, limitations and clinical value of available tools for predicting patient outcome after RC. Our findings suggest that while individual surgical, patient and pathological features provide useful estimates of survival outcome, the inherent heterogeneity of tumour biology and patient characteristics leads to significant variation in outcome. By incorporating all relevant continuous predictive factors for individual patients, integrative predictive models, such as nomograms or artificial neural networks, provide more accurate predictions and generally surpass clinical experts at predicting outcomes. Nonetheless, there is a clear need for the development and validation of molecular biomarkers and their incorporation into multivariable predictive tools. Significant progress has been made in identifying important molecular markers of disease and the development of multifactorial tools for predicting the outcome after RC.     

Economics of stone management

Cost, in addition to efficacy and morbidity, has become an important factor in determining the best therapeutic modality for a variety of disease states. A comprehensive literature search finds that, in general, for staghorn calculi, percutaneous nephrostolithotomy is more cost-effective than shock wave lithotripsy (SWL) for stones greater than 2 cm in any dimension, while SWL may be cost-effective for smaller stones. For ureteral stones, observation is the least costly treatment strategy. Among surgical options, ureteroscopy is less costly than SWL. For single and recurrent stone formers, medical prophylactic strategies involving drug therapy are more costly than conservative therapy involving dietary measures alone. However, drug strategies yield fewer stone recurrences.     

Development of the EEG from 5 months to 4 years of age.

OBJECTIVES: This report provides a systematic longitudinal analysis of the EEG from infancy into early childhood. Particular emphasis is placed on the empirical confirmation of a 6-9 Hz alpha-range frequency band that has previously been used in the infant EEG literature. METHODS: EEG data in 1-Hz bins from 3 to 12 Hz were analyzed from a longitudinal sample of 29 participants at 5, 10, 14, 24, and 51 months of age. RESULTS: Inspection of power spectra averaged across the whole sample indicated the emergence of a peak in the 6-9 Hz range across multiple scalp regions. Coding of peaks in the power spectra of individual infants showed a clear developmental increase in the frequency of this peak. A rhythm in the 6-9 Hz emerged at central sites that was independent of the classical alpha rhythm at posterior sites. The relative amplitude of this central rhythm peaked in the second year of life, when major changes are occurring in locomotor behavior. CONCLUSIONS: The 6-9 Hz band is a useful alpha-range band from the end of the first year of life into early childhood. The findings also complement other research relating the infant central rhythm with the adult sensorimotor mu rhythm.     

Survivin: a promising biomarker for detection and prognosis of bladder cancer

Survivin is a 16.5 kDa member of the inhibitor of apoptosis protein family that is overexpressed in many malignancies but rarely detected in normal differentiated adult tissues. Functionally, Survivin inhibits apoptosis, promotes cell proliferation, and induces/enhances angiogenesis. In transitional cell carcinoma of the urinary bladder, Survivin has been shown to be a promising biomarker for cancer diagnosis, prognosis and prediction of response to intravesical or systemic therapies. Moreover, in pre-clinical bladder tumor models, inhibition of Survivin expression and/or function has been shown to impede tumor cell proliferation, and markedly induce spontaneous or chemotherapy induced apoptosis. These preliminary findings should now be confirmed in large prospective trials. Furthermore, simplified, quantitative and reproducible assays need to be developed and validated for the detection of Survivin and its different isoforms.     

Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts

OBJECTIVES: To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts. MATERIALS AND METHODS: A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups. RESULTS: There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different. CONCLUSIONS: RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.     

Management of pelvic fractures during pregnancy

Pelvic or acetabular fractures during pregnancy are rare, and information on managing such complex incidents has been limited. Over several years, we have gained significant experience in handling such cases. Of the 1345 pelvic and acetabular fractures treated at our level I trauma center between 1987 and 2002, 15 (1.1%) occurred in pregnant women. Eleven women received conservative treatment, and 4 were treated surgically. Of the 16 fetuses, 12 survived, and 4 pregnant women had nonviable pregnancies. One of the 15 pregnant women died. We describe our cases and propose treatment guidelines. The dilemma presented in a multitrauma situation at various stages of pregnancy necessitates making management modifications involving timing of surgery and delivery, use of radiation for imaging, and choice of appropriate surgical procedure.