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Sacral metastases in an endometrial cancer patient after treatment with sequential chemo-radiotherapy: A case report  [PDF]
Bryant Christopher S.,Shah Jay P.,Kumar Sanjeev,Munkarah Adnan R.
Archive of Oncology , 2010, DOI: 10.2298/aoo1002038b
Abstract: The incidence of bone metastases in endometrial cancer is reported to occur in less than 15% of patients with metastatic disease. The medical literature is limited to only case reports, although none describing a sacral recurrence after adjuvant chemo-radiation therapy. We present the case of a 64-year-old woman who underwent surgery for endometrial adenocarcinoma followed by 'sandwich' chemoradiation therapy at our institution, July 2006 (FIGO stage IB grade 3). In spite of adjuvant therapy, which was delivered in August 2008 the patient, developed an isolated sacral recurrence. The optimal therapeutic modality for endometrial cancer patients with high-risk disease remains controversial. The increasing use of combined modality therapy for early stage, high-risk patients may produce different recurrence patterns than described in historical controls.
Sequential allocation to balance prognostic factors in a psychiatric clinical trial
Fossaluza, Victor;Diniz, Juliana Belo;Pereira, Basilio de Bragan?a;Miguel, Eurípedes Constantino;Pereira, Carlos Alberto de Bragan?a;
Clinics , 2009, DOI: 10.1590/S1807-59322009000600005
Abstract: objective: this paper aims to describe and discuss a minimization procedure specifically designed for a clinical trial that evaluates treatment efficacy for ocd patients. method: aitchison's compositional distance was used to calculate vectors for each possibility of allocation in a covariate adaptive method. two different procedures were designed to allocate patients in small blocks or sequentially one-by-one. results: we present partial results of this allocation procedure as well as simulated data. in the clinical trial for which this procedure was developed, successful balancing between treatment arms was achieved. separately, in an exploratory analysis, we found that if the arrival order of patients was altered, most patients were allocated to a different treatment arm than their original assignment. conclusion: our results show that the random arrival order of patients determine different assignments and therefore maintains the unpredictability of the allocation method. we conclude that our proposed procedure allows for the use of a large number of prognostic factors in a given allocation decision. our method seems adequate for the design of the psychiatric trials used as models. trial registrations are available at clinicaltrials.gov nct00466609 and nct00680602.
Prognostic value of intrathecal IgG synthesis in multiple sclerosis: a study in 54 patients
Najafi F,Ghaffarpour M,Najafi M R,Aghamohammadi A
Tehran University Medical Journal , 2008,
Abstract: Background: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system with multifocal areas of demyelination. Despite an increased understanding of the mechanisms causing MS, immunological factors that indicate disease activity are only starting to be discovered. Chronic brain inflammation is often associated with an increase in production of IgG in the CSF as determined by the IgG index (normal ≤0.77) and oligoclonal bands (OCBs). Different studies have found variable correlations between these two factors and disease progression. We herein evaluate the correlation of IgG index and OCB with disease progression in Iranian MS patients.Methods: The IgG index was measured in 54 patients with multiple sclerosis. The progression index (PI), type of disease course and the presence of OCBs were compared in patients with normal, high and very high IgG index.Results: PI was higher in patients with very high IgG indexes (0.10±0.13) vs. patients with high (0.06±0.05) and normal IgG indexes (0.05±0.07; p>0.05). Secondary progressive (SP) patients had higher IgG indexes than those with relapsing-remitting (RR) courses (2.04±1.24 for SP vs. 1.78±1.45 for RR; p>0.05). The PI was higher in OCB-positive MS patients (0.08±0.10) vs. OCB-negative patients (0.05±0.04) (p>0.05).Conclusion: Although the findings of this study need to be treated with some caution since this is not a prospective evaluation, the results indicate a trend toward better prognosis of the disease in patients with lower IgG index values. We think that the IgG index is a useful marker of disease activity in MS. Patients with IgG indexes above 1.1 could have an increased risk of progression and they would benefit from early treatment with immunomodulator agents. Our results did not reveal statistically significant prognostic value for IgG index in patients with multiple sclerosis. Thus the results warrant prospective studies to verify the prognostic value of intrathecal IgG synthesis in multiple sclerosis.
A Radomized Trial of Bronchial Arterial Infusion (BAI), Traditional Vein Chemotherapy and BAI plus Vein Chemotherapy Sequential Therapy in the Treatment of Advanced and Late NSCLC  [cached]
Xiaoying HUANG,Chang YU,Liangxing WANG,Weizhong ZHOU
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and Objective Many patients always late disease when they diagnozed with lung cancer, the therapeutic effect of late lung-cancer was very poor, the aim of this study is to compare therapeutic effect among bronchial arterial infusion (BAI), traditional vein chemotherapy and BAI plus vein chemotherapy sequential therapy, for late NSCLC, and find a better way to treat late lung cancer. Methods One hundred and seven patients with advanced NSCLC were randomly treated by BAI, traditional vein chemotherapy and BAI plus vein chemotherapy sequential therapy. Results Primary lesion's total response rate (RR) of BAI group, traditional vein chemotherapy group and sequential therapy group were: 59.22%, 30.23% and 69.05%, respectively。RR of primary lesion in BAI group was significantly higher than that in traditional vein chemotherapy group (P<0.01), sequential therapy group was much higher than that in traditional vein chemotherapy group (P<0.01), there was no differences between BAI group and sequential therapy group (P>0.05). Metastasis's total response rate (RR) in BAI group, traditional vein chemotherapy group and sequential therapy group were: 18.19%, 53.58%, 60.00%, respectively. RR in metastasis BAI group was significantly lower than that in traditional vein chemotherapy group (P<0.05), sequential therapy group was much higher than that in BAI group (P<0.01), there was no remarkable differences between traditional vein chemotherapy group and sequential therapy group (P>0.05). Conclusion BAI plus vein chemotherapy sequential therapy has good response on both NSCLC primary lesion and metastasis.
Identification of Common Prognostic Gene Expression Signatures with Biological Meanings from Microarray Gene Expression Datasets  [PDF]
Jun Yao, Qi Zhao, Ying Yuan, Li Zhang, Xiaoming Liu, W. K. Alfred Yung, John N. Weinstein
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045894
Abstract: Numerous prognostic gene expression signatures for breast cancer were generated previously with few overlap and limited insight into the biology of the disease. Here we introduce a novel algorithm named SCoR (Survival analysis using Cox proportional hazard regression and Random resampling) to apply random resampling and clustering methods in identifying gene features correlated with time to event data. This is shown to reduce overfitting noises involved in microarray data analysis and discover functional gene sets linked to patient survival. SCoR independently identified a common poor prognostic signature composed of cell proliferation genes from six out of eight breast cancer datasets. Furthermore, a sequential SCoR analysis on highly proliferative breast cancers repeatedly identified T/B cell markers as favorable prognosis factors. In glioblastoma, SCoR identified a common good prognostic signature of chromosome 10 genes from two gene expression datasets (TCGA and REMBRANDT), recapitulating the fact that loss of one copy of chromosome 10 (which harbors the tumor suppressor PTEN) is linked to poor survival in glioblastoma patients. SCoR also identified prognostic genes on sex chromosomes in lung adenocarcinomas, suggesting patient gender might be used to predict outcome in this disease. These results demonstrate the power of SCoR to identify common and biologically meaningful prognostic gene expression signatures.
Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients  [cached]
Govaert Stephanie LA,Troost Esther GC,Schuurbiers Olga CJ,de Geus-Oei Lioe-Fee
Radiation Oncology , 2012, DOI: 10.1186/1748-717x-7-150
Abstract: Purpose The aim of this retrospective cohort study was to assess treatment outcome, and acute pulmonary and esophageal toxicity using intensity modulated (sequential/concurrent chemo)radiotherapy (IMRT) in locally advanced stage III non-small cell lung cancer (NSCLC). Methods and materials Eighty-six patients with advanced stage NSCLC, treated with either IMRT only (66 Gy) or combined with (sequential or concurrent) chemotherapy were retrospectively included in this study. Overall survival and metastasis-free survival were assessed as well as acute pulmonary and esophageal toxicity using the RTOG Acute Radiation Morbidity Scoring Criteria. Results Irrespective of the treatment modality, the overall survival rate for patients receiving 66 Gy was 71% (±11%; 95% CI) after one year and 56% (±14%) after two years resulting in a median overall survival of 29.7 months. Metastasis-free survival was 73% (±11%) after both one and two years. There were no statistically significant differences between the treatment groups. Treatment related esophageal toxicity was significantly more pronounced in the concurrent chemoradiotherapy group (p = 0.013) with no differences in pulmonary toxicity. Conclusions This retrospective cohort study in advanced non-small cell lung cancer patients shows that IMRT is an effective technique with acceptable acute toxicity, also when (sequentially or concomitantly) combined with chemotherapy.
Weak expression of cyclooxygenase-2 is associated with poorer outcome in endemic nasopharyngeal carcinoma: analysis of data from randomized trial between radiation alone versus concurrent chemo-radiation (SQNP-01)
Susan Loong, Jacqueline Hwang, Hui Li, Joseph Wee, Swee Yap, Melvin Chua, Kam Fong, Terence Tan
Radiation Oncology , 2009, DOI: 10.1186/1748-717x-4-23
Abstract: 58 out of 88 patients from this institution had samples available for analysis. COX-2 expression levels were stratified by immunohistochemistry, into negligible, weak, moderate and strong, and correlated with overall and disease specific survivals.58% had negligible or weak COX-2 expression, while 14% and 28% had moderate and strong expression respectively. Weak COX-2 expression conferred a poorer median overall survival, 1.3 years for weak versus 6.3 years for negligible, 7.8 years, strong and not reached for moderate. There was a similar trend for disease specific survival.Contrary to literature published on other malignancies, our findings seemed to indicate that over-expression of COX-2 confer a better prognosis in patients with endemic NPC. Larger studies are required to conclusively determine the significance of COX-2 expression in these patients.Nasopharyngeal carcinoma (NPC) is the sixth most common male cancer in Singapore. The current standard of care for locally advanced NPC is concurrent chemo-radiation, which is associated with increased acute and long term morbidities [1,2]. Increasing effort has been directed toward developing molecular targeted therapies for the treatment of NPC with increasing interest in cyclooxygenase-2 (COX-2) inhibitors.COX-2 is a 68 kDA enzyme that catalyses the conversion of arachidonic acid to prostaglandins. Over-expression of COX-2 has been found in a variety of malignancies, both gastrointestinal (colon, oesophagus, stomach, pancreas) as well as outside the gastrointestinal tract (lung, breast, bladder and cervix), and shown to correlate with poorer outcomes [3-6].We hereby describe a retrospective analysis of 58 samples from patients, diagnosed with endemic NPC, who had previously been randomized into a trial of radiotherapy (RT) alone versus concurrent chemo-radiation (CRT) [7]. The aims of the study were to determine the expression level of COX-2 in our cohort of patients and to correlate this with known prognostic fact
Traditional Chinese Medicine in Cancer Care: A Review of Case Series Published in the Chinese Literature
Guoyan Yang,Xun Li,Xiaoli Li,Lu Wang,Jia Li,Xue Song,Jizhong Chen,Yu Guo,Xiaoxuan Sun,Shana Wang,Zhiqi Zhang,Xiaoyun Zhou,Jianping Liu
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/751046
Abstract: Traditional Chinese medicine (TCM) has been widely used in cancer in China. Case series report a series of cases exposed to a certain intervention. To understand the current situation of case series of TCM for cancer, we performed this review. We included case series of cancer patients treated with TCM therapy. Electronic searches were conducted in four main Chinese databases until February 2011. A total of 1,217 reports of case series (92,945 patients) were included. The top five types of cancer were lung cancer, liver cancer, stomach cancer, leukemia, and esophageal cancer. Leukopenia and hiccup treated by TCM were the most common adverse reactions after surgery or induced by chemo/radiotherapy. More than half of the patients were treated with TCM therapies alone. The application of herbal medicines especially formula based on syndrome differentiation was highly prevalent, and the typical administration route was oral usage. 1,182 reports were published in a structured format. The quantity of TCM case series for cancer treatment is substantial. Further studies should focus on the most common types of cancer and the most frequently applied TCM therapies. We presented a recommendation from the methodological point of view for the format of reporting.
Prognostic Ability of Practitioners of Traditional Arabic Medicine: Comparison with Western Methods through a Relative Patient Progress Scale  [PDF]
Bertrand Graz
Evidence-Based Complementary and Alternative Medicine , 2010, DOI: 10.1093/ecam/nen022
Abstract: The ancient Greek medical theory based on balance or imbalance of humors disappeared in the western world, but does survive elsewhere. Is this survival related to a certain degree of health care efficiency? We explored this hypothesis through a study of classical Greco-Arab medicine in Mauritania. Modern general practitioners evaluated the safety and effectiveness of classical Arabic medicine in a Mauritanian traditional clinic, with a prognosis/follow-up method allowing the following comparisons: (i) actual patient progress (clinical outcome) compared with what the traditional ‘tabib’ had anticipated (= prognostic ability) and (ii) patient progress compared with what could be hoped for if the patient were treated by a modern physician in the same neighborhood. The practice appeared fairly safe and, on average, clinical outcome was similar to what could be expected with modern medicine. In some cases, patient progress was better than expected. The ability to correctly predict an individual's clinical outcome did not seem to be better along modern or Greco-Arab theories. Weekly joint meetings (modern and traditional practitioners) were spontaneously organized with a modern health centre in the neighborhood. Practitioners of a different medical system can predict patient progress. For the patient, avoiding false expectations with health care and ensuring appropriate referral may be the most important. Prognosis and outcome studies such as the one presented here may help to develop institutions where patients find support in making their choices, not only among several treatment options, but also among several medical systems.
Immunology of Photo(chemo)therapy  [PDF]
Ekin ?avk
Turkderm , 2010,
Abstract: Perhaps the oldest empirical therapeutic modality in the history of medicine, photo(chemo)therapy has well documented benefits but its mode of action is not fully elucidated. Today, thanks to advances in photoimmunology and molecular biology we are provided with important clues as to how photo(chemo)therapy works. Initial research on UV light and skin cancer has brought about the groundbreaking discovery of the immunological effects UV. UVB is the UV light most frequently used for therapeutic purposes and its mechanisms of action are best demonstrated. UV light has several distinct effects on various components of the innate and acquired immune systems, especially T lymphocyte functions the common endpoint of which is immune supression. The antiproliferative and antifibrotic therapeutic effects of UVA and UVB have so far not been directly associated with immunological mechanisms.
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