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991.
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Wanebo HJ DiSiena M Begossi G Belliveau J Gustafson E 《Annals of surgical oncology》2008,15(4):1107-1116
Introduction Previously irradiated recurrent rectal cancer is a formidable patient threat with limited treatment options. Isolated pelvic
perfusion (IPP) by the balloon-occlusion technique provides high-dose regional chemotherapy that may facilitate resection
if appropriate or palliate pain and fungating tumor mass in the symptomatic patient. We currently report our results in 49
recurrent rectal cancer patients (26 had neoadjuvant IPP with intent to resect and 23 had IPP for palliation).
Methods IPP was done for 1 hour with paclitaxel 30 mg/m2, 5 fluorouracil 1500 mg/m2, cisplatin/oxaliplatin 60-130 mg/m2, and mitomycin C 10 to 15 mg/m2 (the latter three achieving pelvic-to-systemic drug ratios of 6–9:1).
Results Neoadjuvant perfusion in 26 patients achieved a response in 14 patients (made resectable). Seven had R0 resections (clear
margins), six by abdominal sacral resection (ABSR), and one by an extended APR. Of seven other patients, one had a complete
pathologic response negating planned resection, one had >50% tumor regression in pelvis (but developed distant metastases),
and three refused ABSR. Planned ABSR in two patients was aborted because of complicating cardiovascular issues. A variety
of medical and cancer issues precluded resection in the remaining 12 of these 26 neoadjuvant patients. Within the neoadjuvant
group, median survival was 24 months in the responding (made resectable) group (14 patients) and it was 8 months in the non-resectable
group (12 patients), p = 0.0001. In the responding (made resectable) group, seven patients had R0 resections (median survival 26 months) and seven
patients were not resected (median survival 18 months), p = 0.0198. In the IPP group for palliation, 17 of 23 patients (74%) had significant relief of pain, and other tumor-related
symptoms (mean survival 11 months).
Conclusion Isolated pelvic perfusion using a simplified balloon-occlusion technique has promise in palliation of or augmenting resectability
of advanced rectal malignancy in patients not amenable to treatment with conventional modalities. 相似文献
993.
Pelton GH Harper OL Tabert MH Sackeim HA Scarmeas N Roose SP Devanand DP 《International journal of geriatric psychiatry》2008,23(7):670-676
OBJECTIVE: To assess combined antidepressant and cognitive enhancer treatment in elderly patients presenting with depression plus cognitive impairment. METHODS: Twenty-three elderly (>50 years old) depressed, cognitively impaired (DEP-CI) patients participated in a pilot study. We evaluated whether, after 8 weeks of open antidepressant treatment, donepezil HCl (Aricept) would afford added cognitive benefit compared to placebo in a randomized 12-week trial. A subsample continued in an 8-month extension phase of open treatment with donepezil. Neuropsychological testing (NPT) was performed and antidepressant response monitored at baseline and the 8, 20, and 52-week time points. RESULTS: At 8-weeks, the antidepressant response rate was 61% (14/23). Improvement in SRT immediate recall (SRT-IR; e.g. episodic verbal memory) was observed in responders compared to non-responders. During the 12-week, placebo-controlled, donepezil add-on trial, patients on donepezil showed further improvement in SRT-IR versus patients on placebo. In the open extension phase, patients who continued open donepezil treatment (n = 6) maintained improvement in memory and tended to show an advantage over patients who never received donepezil and were evaluated at the 52-week time point (n = 6). There were no observed significant donepezil effects on non-memory cognitive domains. CONCLUSION: These preliminary findings suggest that addition of a cholinesterase inhibitor (AChEI) following antidepressant medication treatment in elderly Dep-CI patients may improve cognition, and support the need for a confirmatory, larger randomized placebo-controlled trial. 相似文献
994.
Sox HC 《Annals of internal medicine》2007,146(12):891-892
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