Palliative Strategies Research Articles

Management of unilateral neck irradiation in elderly patients with head and neck cancer: Which place for hypofractionation? A single-centre experience of 43 patients

Purpose of the studyThe purpose of the study was to evaluate retrospectively the acute toxicity and efficacy in terms of locoregional control of a cervical lymph node irradiation using a hypofractionated regimen in frail elderly patients. Material and methodsPatients receiving unilateral hypofractionated cervical lymph node irradiation at the Institut de cancérologie de Lorraine (France) were retrospectively included. The treatment regimen consisted of delivering 54Gy in 18 fractions to the high-risk tumour or lymph node volume and 45Gy to the prophylactic volume using the technique of simultaneous integrated-boost without concomitant systemic treatment. Toxicity data according to the Common Terminology Criteria for Adverse Events version 4 and survival data were collected. ResultsForty-three patients were treated between January 2013 and July 2021. The median age was 83 years (range: 78–86.5 years), 32 patients (74.4 %) were male and 25.6 % had WHO status ≥ 2. Histological types were cutaneous squamous cell carcinoma (39 patients), salivary gland carcinoma (three patients) and Merkel cell carcinoma (one patient). The mean duration of treatment was 27 days. Seventeen patients (39.5 %) received radiotherapy alone. Acute toxicity events of grade ≥ 2 at the end of radiotherapy in the 43 patients were described as follows: 58.1 % radiodermatitis (25 patients), 24.6 % mucositis (11 patients), and 18.1 % xerostomia (eight patients). Seven patients (16.3 %) experienced grade ≥ 2 odynodysphagia, with four patients (9.3 %) requiring enteral nutrition. No grade 3 toxicity events were reported at 3 months, 6 months or 1 year. After a median follow-up of 9.2 months (range: 6–18.5 months), 11 patients (25.6 %) of those treated by exclusive irradiation had a complete locoregional response as assessed by CT-scan 3 months. At 6 months, two of 20 patients retained grade 2 xerostomia and only four of 20 patients reported residual grade 1 pain. ConclusionModerately hypofractionated unilateral cervical lymph node radiotherapy appears to be well tolerated in frail elderly patients with an acceptable locoregional control rate, potentially providing an alternative to palliative strategies.

Mutagenic impact and evolutionary influence of radiotherapy in hematologic malignancies.

Ionizing radiotherapy (RT) is a widely used palliative and curative treatment strategy for malignancies. In solid tumors, RT-induced double strand breaks lead to the accumulation of indels, and their repair by non-homologous end-joining has been linked to the ID8 mutational signature in resistant cells. However, the extent of RT-induced DNA damage in hematologic malignancies and its impact on their evolution and interplay with commonly used chemotherapies has not yet been explored. Here, we interrogated 580 whole genome sequencing (WGS) from patients with large B-cell lymphoma, multiple myeloma, and myeloid neoplasms and identified ID8 only in relapsed disease. Yet, it was detected after exposure to both RT and mutagenic chemotherapy (i.e., platinum). Using WGS of single-cell colonies derived from treated lymphoma cells, we revealed a dose-response relationship between RT and platinum and ID8. Finally, using ID8 as a genomic barcode we demonstrate that a single RT-resistant cell may seed systemic relapse.

A National Perspective on Palliative Interventions for Malignant Gastric Outlet Obstruction

BackgroundApproximately 15-20% of patients with duodenal or periampullary malignancies develop GOO. While small, randomized trials have reported more rapid recovery and shorter hospital stay with ES, limited studies have evaluated outcomes on a national level. The present study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) versus endoscopic stenting (ES) in malignant gastric outlet obstruction (GOO). MethodsAdults with malignant GOO treated with ES or GJ were identified in the 2016-2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariable regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission. ResultsOf 8,186 GOO patients, 68.4% underwent ES and 31.6% GJ. The cohorts were similar in age, sex, and comorbidities, while GJ patients were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between GJ and ES. GJ was associated with greater odds of blood transfusion (AOR 1.74 [95% CI [1.37-2.21]) and postoperative TPN use (AOR 3.76 [95% CI 2.64-5.35]). Furthermore, GJ patients experienced a significant increment of +$15,800 in costs and +6.9-day in LOS. On subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable between palliation strategies. ConclusionsES appears to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.

Perinatal palliative care in low- and middle-income countries: a scoping review.

2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied. In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process. A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings. Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.

Mid infrared spectroscopy combined with chemometrics as tool to monitor the impact of heat stress and dietary interventions in lactating sows.

Heat stress in hyper-prolific lactating sows is recognised as a factor reducing feed intake, milk production, and welfare, with significant losses in farm productivity. Individual capacities for body thermoregulation during environmental hyperthermia determine the adaptation of the animal during long and recurrent events. This study aimed to evaluate the ability of attenuated total reflectance (ATR) mid infrared (MIR) spectroscopy as a high-throughput method to identify markers of stress in plasma and milk collected from lactating sows under heat stress conditions fed with two levels of protein in the diet defined as low (16%) and standard (20%). The MIR spectra were analysed using linear discriminant analysis (LDA) and principal component analysis and validated using cross-validation. The results obtained indicated that MIR spectroscopy, in combination with chemometrics, was able to identify changes in the spectra associated with heat stress in wavenumbers corresponding with amide groups (proteins) (highest loadings observed in the regions between1065 and 1635cm-1), lipids and unsaturated fatty acids (regions between 1746 and 3063cm-1), lipo-polysaccharides (in 1247cm-1) and carbohydrates (around the region1050 cm-1). These results also indicated that the information provided by these wavenumbers can be used as metabolic markers of the adaptation of the sows to hyperthermia. It was concluded that MIR spectroscopy is a rapid and inexpensive tool capable of detecting and evaluating the main biochemical changes of hyperthermia on lactating sows, facilitating the development of palliative management strategies such as dietary manipulations.

Comment irradier un patient atteint de carcinome bronchique sous traitement systémique (thérapie ciblée, immunothérapie, agents de chimiothérapie) ?

The management of lung carcinomas, whether small cell or non-small cell, frequently requires a combination of radiation and systemic treatment, both in curative and palliative strategies. However, the introduction of new systemic treatments raises the issue of the feasibility of such combinations due to a significant risk of toxicity. This literature review aims to evaluate the risk situations for toxicity when combining radiation with systemic treatment. In certain situations, optimizing the method of irradiation (sequence, dose) is necessary to improve both feasibility and effectiveness.

Targeting RNA helicase DDX3X with a small molecule inhibitor for breast cancer bone metastasis treatment

Patients who present with breast cancer bone metastasis only have limited palliative treatment strategies and efficacious drug treatments are needed. In breast cancer patient data, high levels of the RNA helicase DDX3 are associated with poor overall survival and bone metastasis. Consequently, our objective was to target DDX3 in a mouse breast cancer bone metastasis model using a small molecule inhibitor of DDX3, RK-33. Histologically confirmed live imaging indicated no bone metastases in the RK-33 treated cohort, as opposed to placebo-treated mice. We generated a cell line from a bone metastatic lesion in mouse and found that it along with a patient-derived bone metastasis cell line gained resistance to conventional chemotherapeutics but not to RK-33. Finally, differential levels of DDX3 were observed in breast cancer patient metastatic bone samples. Overall, this study indicates that DDX3 is a relevant clinical target in breast cancer bone metastasis and that RK-33 can be a safe and effective treatment for these patients.

Perioperative Anesthetic Considerations for Catheter-Based Pulmonary Vein Interventions in Fibrosing Mediastinitis

IntroductionFibrosing mediastinitis is a rare disease characterized by abnormal proliferation of fibrous tissue, causing compression, and narrowing of the airway, blood vessels and other mediastinal structures, including the pulmonary veins. Catheter based interventions are available palliative strategies. Due to the complex nature of the disease and the profound respiratory and hemodynamic sequela that may ensue, anesthetic management requires meticulous interdisciplinary planning. MethodsWe performed a retrospective descriptive study including patients with Fibrosing Mediastinitis undergoing catheter-based interventions for pulmonary vein stenosis from January 2020 to April 2024. A total of fourteen patients underwent chart review and we reported patient sex, preprocedural pulmonary artery pressures, comorbidities, lung isolation strategies, intra-procedural anesthestic complications, post procedural ICU admissions and length of stayResults: All patients underwent pulmonary vasculature angioplasty, with or without stent placement, under general anesthesia with lung isolation capabilities and echocardiogram guidance. 11 of 18 (61%) cases were uncomplicated. 4 of 18 (22%) required unanticipated postoperative ICU care, 2 (11%) in the setting of pulmonary hemorrhage, one due to hypoxic respiratory failure, and one due to difficult airway. One patient developed self-limiting postoperative hemoptysis in two different occasions and one patient developed a vascular access related complication. Mean hospital length of stay (LOS) was 2.6 days (0-13 days) and mean ICU LOS was 1.75 days (1-4 days). One patient presented 6-weeks postoperatively with massive hemoptysis likely secondary to PV rupture and passed away following a protracted ICU course. ConclusionPatients with FM can achieve successful intraprocedural outcomes by ensuring a comprehensive understanding of the disease, addressing significant anesthetic concerns and considerations, and engaging a multi-disciplinary team.

286. TREATMENT WITH CURATIVE INTENT FOR OLIGOMETASTATIC GASTROESOPHAGEAL CANCER-RESULTS OF A PROSPECTIVE MULTICENTER STUDY

Abstract Background Oligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option in selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer. Methods In a multicenter collaborative study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered treatment with combined systemic and local therapy within the study. Primary endpoints were treatment safety and feasibility, secondary outcomes included postoperative mortality, treatment response, progression-free and overall survival. Subgroup analyses were stratified based on oligometastatic location. Results A total of 29/35 patients completed systemic and local treatment with surgical resection, liver ablation or definitive chemoradiotherapy. The majority of postoperative complications were mild-moderate, no patient died due to postoperative complications within 30 days of surgery. Median progression-free survival was 7.1 (interquartile range 4.3-12.4) months and median overall survival was 23.8 (interquartile range 12.3-33.0) months. Conclusion This study found combined systemic and local treatment to be a safe treatment option and to potentially improve long-term survival in strictly selected patients with oligometastatic gastroesophageal cancer.

Enhancing Palliative Care for Deep Vein Thrombosis: A Scoping Review with Clinical Insights on the Integration of Physical Activity

Abstract Objective: This review aims to explore the role of physical activity as an integral palliative care strategy in managing deep vein thrombosis (DVT), providing a comprehensive analysis and practical insights for clinicians. Methods: A thorough review of relevant literature was conducted, encompassing studies, clinical trials, and expert opinions that examine the relationship between physical activity and palliative care from the perspective of DVT. The search included databases such as PubMed, PEDro, and Scopus, with an emphasis on articles published within the last decade. Results: The review highlights the multifaceted benefits of incorporating physical activity into the palliative care approach for individuals with DVT. Physical activity has been effective in enhancing overall well-being, alleviating symptoms, and contributing to the holistic management of DVT-related complications. In addition, the literature underscores the importance of personalized exercise regimens tailored to the patient’s condition, ensuring safety and effectiveness. Conclusion: This comprehensive review underscores the significance of physical activity as a pivotal element in palliative care for individuals with DVT. Integrating personalized exercise regimens into the management strategy offers a holistic approach that addresses the physical and psychosocial aspects of DVT. As clinicians navigate the complexities of DVT palliative care, a thorough and timely incorporation of physical activity can significantly contribute to enhancing the overall quality of life for affected individuals.

Characterization of the palliative management of patients with stage IV gastrointestinal tract cancer in a hospital in southern Colombia

Introduction: Gastrointestinal neoplasms are a group of malignant pathologies that cause high indices of morbimortality throughout the world. when diagnosed around 35% of cancer patients are classified as stage IV. Knowing the increasing incidence of gastrointestinal tumors and the need to offer care to those in advanced stages, it was necessary to characterize the palliative care offered to stage IV gastrointestinal cancer patients in the southern region of Colombia Materials and methods: All patients with ICD-10 diagnosis of esophageal, gastric, colon and rectum cancer classified as clinical stage IV. Data collection was obtained from the clinical records of the patients and registered into an excel Version 15.31 design instrument. Data was analyzed using standard descriptive statistics. Statistical analysis were performed using Stata 15 ®. Results: 285 were included. majority were male 63.16%, the average age was 61.08 years. The most frequent tumors found were those located in the stomach corresponding to 54.74% of the cases and of these the antral tumors were most reported 19.3%. The palliative management strategies for the group of patients studied were mostly aimed at medical management, especially related to comfort support measures in 55.09% Conclusions: Stage IV gastrointestinal neoplasms were characterized alongside with their palliation strategies. The most frequent palliation treatment was based on comfort measures, invasive strategies are considered an option. More studies are required to optimize the data collection and diminish bias risk.

Comparison of Ductal Stent Versus Surgical Shunt as Initial Intervention for Neonates with Pulmonary Atresia with Intact Ventricular Septum.

Data comparing surgical systemic-to-pulmonary artery shunt and patent ductus arteriosus (PDA) stent as the initial palliation procedure for patients with pulmonary atresia with intact ventricular septum (PA-IVS) are limited. We sought to compare characteristics and outcomes in a multicenter cohort of patients with PA-IVS undergoing surgical shunts versus PDA stents. We retrospectively reviewed neonates with PA-IVS from 2009 to 2019 in 19 United States centers. Bivariate comparisons and multivariable logistic regression analysis were performed to determine the relationship between initial palliation strategy and outcomes including major adverse cardiovascular events (MACE): stroke, mechanical circulatory support, cardiac arrest, or death. Included were 187 patients were included: 38 PDA stents and 149 surgical shunts. Baseline characteristics did not differ statistically between groups. Post-procedural MACE occurred in 4 patients (11%) with PDA stents versus 38 (26%) with surgical shunts, p = 0.079. Overall, the initial palliation strategy was not significantly associated with MACE (aOR:0.37; 95% CI,0.13-1.02). In patients with moderate-to-severe right ventricle hypoplasia, PDA stents were significantly associated with decreased odds of MACE (aOR:0.36; 95% CI,0.13-0.99). PDA stents were associated with lower vasoactive inotrope scores (median 0 versus 5, p < 0.001), greater likelihood to be extubated at the end of their procedure (37% versus 4%, p < 0.001), and shorter duration of mechanical ventilation (median 24 versus 96h, p < 0.001). PDA stents were associated with significantly more unplanned reinterventions for hypoxemia compared to surgical shunts (42% vs. 20%, p = 0.009). In this multicenter study, neonates with PA-IVS who underwent PDA stenting received less vasoactive and ventilatory support postoperatively compared to those who had surgical shunts. Furthermore, patients with the most severe morphology had decreased odds of MACE.

The American Association for Thoracic Surgery (AATS) 2024 expert consensus document: Management of neonates and infants with Ebstein anomaly

ObjectivesSymptomatic neonates and infants with Ebstein anomaly (EA) require complex management. A group of experts was commissioned by the American Association for Thoracic Surgery to provide a framework on this topic focusing on risk stratification and management. MethodsThe EA Clinical Congenital Practice Standards Committee is a multinational and multidisciplinary group of surgeons and cardiologists with expertise in EA. A citation search in PubMed, Embase, Scopus, and Web of Science was performed using key words related to EA. The search was restricted to the English language and the year 2000 or later and yielded 455 results, of which 71 were related to neonates and infants. Expert consensus statements with class of recommendation and level of evidence were developed using a modified Delphi method, requiring 80% of members votes with at least 75% agreement on each statement. ResultsWhen evaluating fetuses with EA, those with severe cardiomegaly, retrograde or bidirectional shunt at the ductal level, pulmonary valve atresia, circular shunt, left ventricular dysfunction, or fetal hydrops should be considered high risk for intrauterine demise and postnatal morbidity and mortality. Neonates with EA and severe cardiomegaly, prematurity (<32 weeks), intrauterine growth restriction, pulmonary valve atresia, circular shunt, left ventricular dysfunction, or cardiogenic shock should be considered high risk for morbidity and mortality. Hemodynamically unstable neonates with a circular shunt should have emergent interruption of the circular shunt. Neonates in refractory cardiogenic shock may be palliated with the Starnes procedure. Children may be assessed for later biventricular repair after the Starnes procedure. Neonates without high-risk features of EA may be monitored for spontaneous closure of the patent ductus arteriosus (PDA). Hemodynamically stable neonates with significant pulmonary regurgitation at risk for circular shunt with normal right ventricular systolic pressure should have an attempt at medical closure of the PDA. A medical trial of PDA closure in neonates with functional pulmonary atresia and normal right ventricular systolic pressure (>20-25 mm Hg) should be performed. Neonates who are hemodynamically stable without pulmonary regurgitation but inadequate antegrade pulmonary blood flow may be considered for a PDA stent or systemic to pulmonary artery shunt. ConclusionsRisk stratification is essential in neonates and infants with EA. Palliative comfort care may be reasonable in neonates with associated risk factors that may include prematurity, genetic syndromes, other major medical comorbidities, ventricular dysfunction, or sepsis. Neonates who are unstable with a circular shunt should have emergent interruption of the circular shunt. Neonates who are unstable are most commonly palliated with the Starnes procedure. Neonates who are stable should undergo ductal closure. Neonates who are stable with inadequate pulmonary flow may have ductal stenting or a systemic-to-pulmonary artery shunt. Subsequent procedures after Starnes palliation include either single-ventricle palliation or biventricular repair strategies.

Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds.

This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL. This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models. A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds. The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.

Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan

IntroductionIn Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards.The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. MethodsThis cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. ResultsOur analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. ConclusionImplementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.

Difficulties of Reading in French Subject Among Morrocan Middle School Students: Case of Learners in First Year of the Secondary School

As part of the French language teaching staff in the secondary school, we have observed during our French reading activities in the classroom that some of our learners face difficulties in the area of reading, specifically in decoding words, phrases, and texts. These difficulties, which poses a real challenge for us as French teachers and for learners struggling with reading, has led us to write this paper where we aim to analyze the reading errors of these learners by identifying, describing, and explaining their origins. The results of our analysis can serve as a basis for planning remedial activities and developing palliative strategies for teachers and inspectors. The ultimate goal is to support and assist the learners in overcoming the difficulties they encounter in learning this foreign language.

Staged repair of borderline hypoplastic heart disease with early biventricular conversion

ObjectiveIn select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age. MethodsBetween 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion. ResultsOf the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months). ConclusionsIn select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation.

Recent Advances in Structural Optimization of Quinazoline-Based Protein Kinase Inhibitors for Cancer Therapy (2021-Present).

Cancer is a complicated, multifaceted disease that can impact any organ in the body. Various chemotherapeutic agents have a low selectivity and are very toxic when used alone or in combination with others. Resistance is one of the most important hurdles that develop due to the use of many anticancer therapeutics. As a result, treating cancer requires a target-specific palliative care strategy. Remarkable scientific discoveries have shed light on several of the molecular mechanisms underlying cancer, resulting in the development of various targeted anticancer agents. One of the most important heterocyclic motifs is quinazoline, which has a wide range of biological uses and chemical reactivities. Newer, more sophisticated medications with quinazoline structures have been found in the last few years, and great strides have been made in creating effective protocols for building these pharmacologically active scaffolds. A new class of chemotherapeutic agents known as quinazoline-based derivatives possessing anticancer properties consists of several well-known compounds that block different protein kinases and other molecular targets. This review highlights recent updates (2021-2024) on various quinazoline-based derivatives acting against different protein kinases as anticancer chemotherapeutics. It also provides guidance for the design and synthesis of novel quinazoline analogues that could serve as lead compounds.

Endoscopic spray cryotherapy for dysphagia palliation in esophageal cancer: Systematic review and meta-analysis.

Background and study aims Endoscopically delivered liquid nitrogen spray cryotherapy is reported to be a safe and possibly more effective strategy for dysphagia palliation in patients with advanced esophageal cancer. This systematic review and meta-analysis aimed to pool all available data to evaluate the impact of this treatment modality. Methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2005 through June 2023 were searched for studies evaluating endoscopically delivered liquid nitrogen spray cryotherapy for dysphagia palliation in patients with advanced esophageal cancer. Pooled proportions were calculated using random-effects (DerSimonian-Laird) model. Results From an initial 895 studies, data were extracted and analyzed from five studies comprising a total of 230 patients that met inclusion criteria. In this pooled analysis, dysphagia improved or did not deteriorate in 81.40% of patients (95% confidence interval [CI] 73.75-87.99). Significant improvement in dysphagia was reported by 55.19% of patients (95% CI 29.62-79.37). An alternate method of dysphagia palliation despite spray cryotherapy was required in 18.78% of patients (95% CI 8.09-32.63) with 10.56% (95% CI 2.53-23.18) requiring esophageal stents. The weighted mean number of spray cryotherapy sessions per patient was 3.37 (95% CI 2.55-4.18). The pooled major adverse event rate was 3.26% (95% CI 0.15-10.14). Conclusions Endoscopic liquid nitrogen spray cryotherapy can effectively and safely treat dysphagia in esophageal cancer. It can be considered an option for dysphagia palliation in centers with expertise and equipment.

The Efficacy of Prostatic Artery Embolization (PAE) as Palliative Therapy in Prostate Cancer

Introduction: Prostate cancer, the primary contributor to cancer-related fatalities in Western countries, predominantly impacts individuals between the ages of 45 and 60. The World Health Organization (WHO) has documented 1,414,259 new cases worldwide. Diagnosis methods include prostate biopsy, PSA testing, and MRI, with risk factors such as age, weight, race, and family history contributing to the varied epidemiology of the disease. Treatment alternatives such as surgery and radiation therapy come with notable side effects, prompting ongoing research into alternatives like prostate artery embolization (PAE) for benign prostatic obstruction. However, the role of PAE in patients with prostate cancer remains uncertain. Aim: The purpose of this systematic review is to determine the efficacy of Prostatic Artery Embolization as one of the palliative management strategies for clinical outcomes in prostate cancer. Method: We searched for English-language full-text literature from Pubmed, Cochrane, Wiley Library, Proquest, SpringerLink, and ScienceDirect databases from January 2013 to Desember 2023. Based on the 1442 journals identified in this study, the number of evaluated articles is 6. Results: In six studies, PAE induces tissue ischemia through femoral artery embolization, offering promise for localized prostate cancer treatment. Administered under local anesthesia, PAE has shorter hospital stays and is well-tolerated compared to TURP. After PAE treatment, significant IPSS reduction occurred, with improved outcomes reported at 1 and 6 months. Histopathology showed necrotic zones, but viable cancer cells persisted. PAE is a valuable adjunctive therapy for reducing organ-at-risk doses in exclusive prostate radiation therapy. Conclusion: PAE is a minimally invasive treatment for LUTS related to BPH and its potential in managing PCa. PAE, utilizing femoral artery occlusion, shows significant short and medium-term reductions in IPSS. While there's notable success in PCa management and reduced radiation doses, further research is essential for a comprehensive understanding of PAE's efficacy in localized PCa treatment.