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1.
Ignacio Aguirre-Allende Jose Maria Enriquez-Navascues Garazi Elorza-Echaniz Ane Etxart-Lopetegui Nerea Borda-Arrizabalaga Yolanda Saralegui Ansorena Carlos Placer-Galan 《Cirugía espa?ola》2021,99(2):89-107
Local excision (LE) has arisen as an alternative to total mesorectal excision for the treatment of early rectal cancer. Despite a decreased morbidity, there are still concerns about LE outcomes.This systematic-review and meta-analysis design is based on the “PICO” process, aiming to answer to three questions related to LE as primary treatment for early-rectal cancer, the optimal method for LE, and the potential role for completion treatment in high-risk histology tumors and outcomes of salvage surgery.The results revealed that reported overall survival (OS) and disease-specific survival (DSS) were 71%–91.7% and 80%–94% for LE, in contrast to 92.3%–94.3% and 94.4%–97% for radical surgery. Additional analysis of National Database studies revealed lower OS with LE (HR: 1.26; 95%CI, 1.09–1.45) and DSS (HR: 1.19; 95%CI, 1.01–1.41) after LE. Furthermore, patients receiving LE were significantly more prone develop local recurrence (RR: 3.44, 95%CI, 2.50–4.74). Analysis of available transanal surgical platforms was performed, finding no significant differences among them but reduced local recurrence compared to traditional transanal LE (OR:0.24;95%CI, 0.15–0.4). Finally, we found poor survival outcomes for patients undergoing salvage surgery, favoring completion treatment (chemoradiotherapy or surgery) when high-risk histology is present.In conclusion, LE could be considered adequate provided a full-thickness specimen can be achieved that the patient is informed about risk for potential requirement of completion treatment. Early-rectal cancer cases should be discussed in a multidisciplinary team, and patient's preferences must be considered in the decision-making process. 相似文献
2.
Luisa Sisinni Ignasi Gich Monserrat Torrent Isabel Badell 《Anales de pediatría (Barcelona, Spain : 2003)》2019,90(3):157-164
Introduction
Survival after hematopoietic stem cell transplantation has improved dramatically in recent years. Unfortunately, there is an increased risk of subsequent malignant neoplasms (SMN) in this population and this represents a significant cause of late mortality.Patients and methods
In this study, we analyzed the incidence of SMN and the associated risk factors in patients referred at a pediatric age for hematopoietic stem cell transplantation (allogeneic or autologous) in our center.Results
We observed 19 cases of SMN in a cohort of 371 patients, with a cumulative incidence of 6, 12, and 36% at 15, 20, and 30 years of follow-up, respectively. The solid tumors were the most prevalent malignancies. The risk was significantly higher than expected in the general population for each tumor type and in the different age ranges (p< .0001). Radiotherapy and chronic GvHD were the main risk factors for the development of SMN in our series.Conclusions
We observed a high incidence of SMN among hematopoietic stem cell transplantation survivors highlighting the need for life-long surveillance. 相似文献3.
J. Caño-Velasco F. Herranz-Amo G. Barbas-Bernardos L. Polanco-Pujol E. Lledó-García C. Hernández-Fernández 《Actas urologicas espa?olas》2019,43(1):18-25
Introduction and objectives
The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours.Material and methods
A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n = 145) or radiotherapy and androgen blockade (n = 141). The homogeneity of both series was analysed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours.Results
The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (P = .29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR = 2.41, 95%CI: 1.31-4.34, P = .005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors.Conclusions
The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled. 相似文献4.
J. Caño-Velasco F. Herranz-Amo G. Barbas-Bernardos L. Polanco-Pujol F. Verdú-Tartajo E. Lledó-García C. Hernández-Fernández 《Actas urologicas espa?olas》2019,43(4):190-197
Introduction
In patients with high-risk localized prostate cancer (HRPCa), multimodal treatment plays a fundamental role.Objective
To compare relapse-free survival (RFS) in patients with HRPCa, treated primarily with radiotherapy (RT) + hormone therapy (HT) versus radical prostatectomy (RP) and salvage RT (sRT) ± HT when biochemical recurrence (BCR) appears.Material and methods
Retrospective analysis of 226 patients with HRPCa (1996-2008), treated primarily with RT + HT (n = 137) or RP (n = 89). The Kaplan-Meier method has been used to evaluate survival and the log-rank test has been used to evaluate the contrast between the different categories of the variables. Multivariate analysis has been performed using Cox regression to determine variables with an impact on RFS with statistical significance (P < 0.05).Results
The median follow-up of the series was 111 (IQR 85-137.5) months. After RT + HT, 32 (23.4%) patients relapsed, and after RP (P = 0.0001), 41 (46.1%) cases. When comparing the primary treatments, the RFS at 5 and 10 years was higher after RT + HT versus RP in monotherapy (P = 0.001). The primary treatment with RT + HT reduced the risk of BCR when compared to the RP (HR = 0.41, P = 0.002). The estimation of the RFS at 5 and 10 years after RP + sRT ± HT was 89.7 and 87.1%, while after primary RT + HT was 91.6 and 71.1%, respectively (P = 0.01). The only factor that behaved as an independent predictor of RFS was the multimodal treatment with RP + sRT ± HT when BCR showed up (HR = 2.39, P = 0.01).Conclusion
In HRPCa, multimodal treatment with RP + sRT ± HT if BCR, significantly improves RFS with respect to treatment with RT + HT. 相似文献5.
Katty Camila Anaya Reyes Daniela Lynett Barrera Gabriel Burgos-Angulo Sergio Eduardo Serrano Gómez Ricardo Flaminio Rojas López 《Piel》2018,33(3):156-161
Introduction
Bowen's disease is a squamous cell carcinoma in situ. Its prevalence is higher in women, and mainly occurs in sun-exposed skin. It typically presents as well-demarcated scaly plaques. Multiple treatments currently exist, with the most common being surgical excision. Using several cases, this study describes the clinical and demographic characteristics of this disease in Bucaramanga, Colombia, with this being the first data reported on this condition in Latin-America.Methods
A case series study was conducted that included patients from 2005 to 2017 with a clinical and histological diagnosis of Bowen's disease. Cases were extracted from the database of an outpatient department of a high-complexity centre in Bucaramanga, Colombia.Results
A total of 64 cases were analysed. Women were more commonly affected than men (67.2%) with a 2:1 ratio. The most affected area was the lower extremities (34.3%), and the classic lesion was present in 92.2% of the cases, followed by pigmented lesions (6.2%). Surgical excision was performed on 57.9% of the patients, and persistence of the lesions was found in 6.2% of the cases, with all of them being treated initially with imiquimod.Discussion
No significant differences were found in the clinical or demographic distribution or in the treatment performed compared with world literature. Nonetheless, a higher frequency of multiple lesions in atypical locations, and pigmented lesions were observed, with no identified risk factor to account for these results. 相似文献6.
Ricardo Bartel Xavier Gonzalez-Compta Enric Cisa Francesc Cruellas Alberto Torres Aleix Rovira Manel Manos 《Acta otorrinolaringologica espanola》2018,69(4):208-213
Introduction and objectives
Olfactory neuroblastoma (ONB) is a rare entity that constitutes less than 5% of nasosinusal malignancies. Mainstream treatment consists in surgical resection +/? adjuvant radiotherapy. By exposing results observed with apparition of new therapeutic options as neoadjuvant chemotherapy, the objective is to evaluate a series and a review of the current literature.Methods
A retrospective review was conducted including patients diagnosed and followed-up for ONB from 2008 to 2015 in our institution.Results
9 patients were included. Mean follow-up of 52.5 months (range 10–107). Kadish stage: A, 1 patient (11.1%) treated with endoscopic surgery; B, 2 patients (22.2%) treated with endoscopic surgery (one of them received adjuvant radiotherapy); C, 6 patients (66.7%), 4 patients presented intracranial extension and were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. The other 2 patients presented isolated orbital extension, treated with radical surgery (endoscopic or craniofacial resection) plus radiotherapy. The 5-year disease free and overall survival observed was 88.9%.Conclusion
Neoadjuvant chemotherapy could be an effective treatment for tumor reduction, improving surgical resection and reducing its complications. 相似文献7.
Mitat Arıcıgil Mehmet Akif Dündar Abitter Yücel Hamdi Arbağ Abdullah Arslan Meryem Aktan Sıdıka Fındık İbrahim Kılınç 《Revista brasileira de otorrinolaringologia (English ed.)》2018,84(2):206-211
Introduction
To manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications.Objective
In this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day.Methods
Thirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day.Results
Histopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-α, interleukin-1β, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interleukin-10 was higher in the radiotherapy plus hyperbaric oxygen group.Conclusion
When radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury. 相似文献8.
《Neurocirugía (Asturias, Spain)》2020,31(1):14-23
Hemangiopericytoma and Solitary Fibrous Tumor are tumors with low incidence. They have a tendency to recur locally and to metastasize. The WHO integrated both tumors into a new entity but one of the pending issues is to demonstrate the effectiveness of surgery plus complementary radiotherapy (RT) and standardize the use of it. We reviewed the data from 10 years. We assessed pathologic and radiologic characteristics. The operation records were evaluated to determine the features and extent of tumor resection. We compared the outcomes in patients using or not RT. The mean follow-up was 74.8 months, with a range of 12 and 210 months. The population included 3 males (30%) and 7 females (70%). The most common location was brain convexity (30%), the remaining were cervical and lumbar spine, sacrum, intraventricular, torcular, sphenoid ridge and intraorbital. Postoperative external beam radiotherapy was delivered in 7 patients (70%), the criteria were a partial resection or WHO II and III histological grades. 2 patients developed local recurrences at 12 and 19 months after initial surgery. 1 patient underwent 2 surgeries, and the other, 4 surgeries. The mean recurrence free survival rate was 15.5 months. Distant metastases were found in 4 patients. 3 of the 10 patients died. Five-year overall survival rate was 66% and mean overall survival was 76 months. A safe and complete resection in the first surgery is the most important prognostic factor. Complementary RT can be helpful, even in cases of complete resection in WHO low-grade. 相似文献
9.
Rosa M. Bermejo Ana M. Palacios Begoña Bermejo Antonio Simón Carmen Díaz-Caneja 《Progresos de Obstetricia y Ginecología》2008
Advanced lymphoma and leukemia can infiltrate the uterus and vagina. However, primary lymphomas affecting the female reproductive system are extremely uncommon (representing 1% of non-nodal tumors). We present a case of primary non-Hodgkin’s lymphoma of the vagina, diffuse large B cell type, stage IE according to the Ann-Arbor staging system. Complete remission was obtained after treatment with chemotherapy and radiotherapy. Five years after diagnosis, the patient is disease free. 相似文献
10.
《Revista espa?ola de cardiología》2021,74(12):1055-1062
Introduction and objectivesEconomic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial.MethodsWe performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography–guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N = 306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system.ResultsThe index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9 ± 6236.8 € vs 14 038.7 ± 4958.5 €; P < .001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5 ± 4568.0 vs SelR 2653.9 ± 5709.1; P = .697). Total cost was 22 081.3 ± 7505.6 for the ComR arm and 16 692.6 ± 7669.9 for the SelR group (P < .001).ConclusionsIn the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty.Study registred at ClinicalTrial.gov (Identifier: NCT01179126). 相似文献