Treatment Of Recurrence In Patients Research Articles

Stereotactic radiosurgery with oxygen radiosensitization in the treatment of multiforme glioblastoma

Glioblastoma multiforme (mGBM) is the most frequent and most primary malignant neoplasm of the central nervous system. Despite current standard treatment protocols such as aggressive surgical resection, radiation therapy, and chemotherapy, the aggressive nature of mGBM results in poor survival. This is largely due to its radioresistance, due to the hypoxia of tumor cells, which are resistant to various chemotherapy regimens, including radiation therapy. Purpose. To assess the effectiveness of radiosurgical treatment of recurrence in patients with mGBM after surgical resection and chemotherapy, using oxygen radiosensitization. Materials and methods. Our study included 26 patients with relapsed mGBM who underwent SRS with oxygen radiosensitization. 12 patients were the control group, without radiosensitization. The study primarily determined the role of oxygen radiosensitization of the tumor, the dose of radiosurgical treatment, the volume of the tumor, and the degree of oxygenation according to MRI data (BOLD programs). Oxygenation was carried out using the Oxy 6000 oxygenator. The effectiveness of radiosurgical treatment was assessed by overall and recurrence-free survival, as well as by the degree of treatment toxicity. The results. Median overall survival (OSS) was 20 months in patients who received SRS with radiosensitization compared with 12 months in those who received SRS without radiosensitization. Relapse-free survival (FFS) in the study group was 15 months, against 8 in the control group (p = 0.004; X 2 = 8.166). Conclusion. SRS is a fairly effective and reliable strategy in the treatment of recurrence of glioblastoma multiforme after surgical resection of the tumor and chemoradiotherapy. Radiosensitization with oxygen during SRS of hypoxic radioresistant glioblastomas improves overall survival by 60.0% and recurrence-free survival by 53.3% compared to the control group. Oxygen is a powerful radiosensitizer that significantly increases the radiosensitivity of tumor cells by increasing the oxygen saturation of hypoxic cells.

Rilonacept: A Newly Approved Treatment for Recurrent Pericarditis.

To review the pharmacology, efficacy, and safety of rilonacept for the prevention and treatment of recurrent pericarditis (RP). A MEDLINE search was conducted between January 2006 and April 2021 using the following terms: rilonacept, pharmacology, pericarditis, recurrent pericarditis, interleukin (IL) antagonist, and pharmacology; prescribing information was also used. English-language studies assessing pharmacology, efficacy, and safety of IL antagonists were reviewed. Rilonacept traps IL-1α and IL-1β. In the Phase III trial, rilonacept was associated with a lower risk of recurrence, more persistent clinical response, and higher amount of days with no or minimal pericarditis symptoms, compared with placebo. The median time to pain response was 5 days, and median time to normalization of C-reactive protein was 7 days with rilonacept. All patients receiving rilonacept during the run-in period were able to be weaned off of standard background therapy, leading to transition to rilonacept monotherapy. The most common adverse effects were upper respiratory tract infections and injection site reactions. Rilonacept may be used for the prevention and treatment of multiple recurrences in patients receiving background therapy for RP, and reduction in risk of recurrence in adults and adolescents ≥12 years with elevated C-reactive protein. Rilonacept may be considered to wean patients from standard background therapy. Rilonacept is a safe, once weekly, subcutaneously administered IL-1 "trap," indicated for the treatment of RP, and reduction in risk of recurrent pericarditis in adults and children ≥12 years of age.

Biochemical, Pharmacological, and Therapeutic Effects of Triple Antihypertensive Therapy with Amlodipine, Valsartan and Hydrochlorothiazide in Elderly Hypertensive Patients with Calcium Phosphate Nephrolithiasis

Antihypertensives are widely prescribed in the geriatric population and could influence kidney stone risk but many aspects are still unknown. Thiazides are used to control lithogenic factors and recurrences in patients with calcium lithiasis. The aim of our study was to evaluate the relationship between essential arterial hypertension and stone disease, by studying the pharmaco-therapeutic effects of a fixed-dose combination of amlodipine + valsartan + hydrochlorothiazide (Aml + Val + HCTZ) 10/320/25 mg, on the urinary stone risk in a study group of hypertensive geriatric patients. A longitudinal, randomized, three years follow-up clinical and experimental study was conducted during June 1, 2014 - July 31, 2017. A number of 60 eligible geriatric patients, treated only with a fixed-dose combination of Aml + Val + HCTZ 10/320/25 mg, as a single-tablet, were enrolled in the study. All the patients were stone formers, with more than three episodes of crystalluria in the last two years. The patient�s age ranged between 55 and 65 years. Exclusion criteria: patients with heart failure, kidney chronic diseases, use of drugs known to affect renal function, patients with multi-morbidities. All patients had similar blood pressure values, and tension was well controlled throughout the whole study period. In the elderly patients, the treatment with 25 mg/day of hydrochlorothiazide (from the combination of Aml + Val + HCTZ 10/320/25 mg) has a beneficial and prolonged efficacy in treatment of recurrences in patients with calcium oxalate and phosphate lithiasis Our study reveals that in the elderly patients with hypertension and nephrolithiasis as a comorbidity, thiazides - 25 mg/day of hydrochlorothiazide (from the combination of Aml + Val + HCTZ 10/320/25 mg) has a beneficial effect in order to control lithogenic factors and recurrences in patients with calcium phosphate lithiasis.

Possibilities of using radiotherapy in the treatment of vaginal recurrence in patients with uterine cancers

A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to...

Papel de las tiazidas en la profilaxis de la litiasis cálcica recidivante

ObjectiveTo show the prolonged efficacy of thiazides in the prophylaxis and treatment of recurrences in patients with calcium oxalate and phosphate lithiasis. MethodsA randomised prospective study is conducted, with a three-year follow-up, in 150 patients diagnosed with recurrent calcium lithiasis. The patients are divided into three groups: A) 50 cases subject to observation with no treatment, B) 50 cases treated with 50 mg/day of hydrochlorothiazide, and C) 50 cases treated with 50 mg of hydrochlorothiazide and 20 mlEq of potassium citrate/day. Each group is subject to a renal study with imaging techniques and a urinary metabolic study at baseline, 12, 24 and 36 months. ResultsThe patients treated with thiazides (Groups B and C) obtain a significant reduction in lithiasis recurrence compared with the control group (Group A). The most common abnormality found in the metabolic study was hypercalciuria, 52% of cases; 16% present a mixed lithogenic pattern. The number of recurrences and need for new sessions of extracorporeal lithotripsy in patients with hypercalciuria treated with thiazides is significantly smaller than in Group A (p=0.003) ConclusionsWe observe a significant relation between lithogenic pattern and lithiasis recurrence. Thiazides help us to control lithogenic factors and recurrences in patients with calcium lithiasis. This effect is prolonged and significant in patients with hypercalciuria.

Progrès dans la chirurgie d’exérèse des métastases hépatiques des cancers colorectaux

Liver resection is the only curative option offering long-term survival in patients with colorectal liver metastases (25 to 40% five-year survival). It can be achieved with low mortality and low morbidity. However, this surgical approach can be offered only for approximately 10 to 20% of patients with colorectal liver metastases. Therefore, 80 to 90% of patients are excluded from liver surgery and will receive palliative therapies. Recent advances have selected subgroups of patients presenting initially unresectable disease to achieve curative resection. These new multidisciplinary strategies were developed in order to increase safely the resecability in patients with initially non-resectable liver metastases and to improve treatment of recurrences in patients with isolated liver metastases either by repeat hepatectomies or local tumor destruction. These strategies offer the same survival than observed in patients with initially resectable liver metastases. Our series includes 438 patients operated on for colorectal liver metastases between 1987 and 2002. Overall mortality was 1.1%, morbidity was 26%. Actuarial 5-year and 10-year survival were respectively 29.6% and 20.1%.

Squamous Cell Carcinoma of the Nasopharynx&An Analysis of Treatment Results in 149 Consecuti v e Patients

The purpose of this study was to evaluate the outcome of primary treatment and treatment of recurrences in patients with nasopharyngeal carcinoma. The material included 149 consecutive patients seen at the Aarhus University Hospital from 1963 to 1991 (49 females and 100 males). The stage distribution was: Stage I –9%, II–3%, III–28%, and IV–60%. Primary treatment was delivered with curative intent in 145 patients (97%). Persistent or recurrent disease after primary radical treatment was observed in 82 of the patients; 54% at the T-level, 40% at the N-level, and 33% at the M-level. A curative salvage attempt was carried out in 14 patients only, all with nodal recurrence: surgery in 8 patients (4 controlled) and radiotherapy in 6 patients (2 controlled). The 5-year local tumour control, locoregional tumour control, disease-specific survival rate and the overall survival rate for the patients treated with curative intent were 66%, 53%, 50% and 43%, respectively. Most of the patients (88%) had poorly differentiated tumours and these patients had the best prognosis. A major complication in three patients was radiation-induced myelopathy due to high-dose radiation delivered to the brain stem. Significant positive prognostic factors for treatment outcome in univariate analyses were early T-classification, small clinical stage, poor differentiation and low age. The Cox multivariate analysis showed that early T-categories, low N-categories and poor differentiation were independent, positive prognostic factors. Nasopharyngeal carcinoma is curable with primary radiotherapy; patients with poorly differentiated tumours have the best prognosis. Only a few patients were salvaged after recurrence. The factor most essential for success is primary control of the disease at the T- and N-levels.

Oral Cancer - Results of Treatment in the Copenhagen University Hospital

During the period 1992-96, 304 patients with malignant tumours of the oral cavity were treated in Copenhagen University Hospital. The female:male ratio was 1:2. Age ranged between 20 and 96 years, median 61 years. Ninety-five percent of the tumours were squamous cell carcinomas. Twenty-two percent were in stage I, 21% were in stage II, 21% were in stage III and 36% were in stage IV. Sixty percent of the patients underwent primary surgical resection, combined with reconstructive procedures if necessary. In 39% of all cases, surgery was followed by radiotherapy, while 21% of the patients, mainly stage I and II patients, were only treated surgically. Radiotherapy alone was received by 36% of the patients, mainly stage III and IV. Four percent of the patients received no treatment due to advanced disease or general poor condition. The overall recurrence rate was 42%, ranging from 23% in stage I to 61% in stage IV. Thirty-eight percent of these patients were treated for recurrence, almost exclusively by surgery. The survival rate 1 year after treatment of recurrence was 90%, 60% and 50% for patients in stage I, II and III respectively, while only 1 of 16 patients in stage IV was alive after 1 year. Three-year crude survival for the whole material was 42%, ranging from 58% in stage I to 18% in stage IV. This is an improvement of 12% compared with a similar group of patients treated in our departments in the period 1978-82, when the primary treatment of choice was external irradiation. The survival rate was, as expected, closely related to T- and N-stage at time of diagnosis. In conclusion, we recommend primary surgery followed by irradiation therapy for patients in stages II, III and IV. Surgical treatment of recurrence in patients who were formerly treated by irradiation therapy should be reserved for patients in good general condition and in a low TNM stage, stage IV patients will only benefit from salvage surgery in a few exceptional cases.

Neodymium: Yttrium-aluminum-garnet laser for the treatment of tracheobronchial recurrences in esophageal carcinomas

Tracheobronchial recurrence occurred in 55 of 559 patients (9.8%) after resection of their esophageal carcinomas and in 22 of 109 patients (20.2%) after a bypass operation. The risk of airway recurrence increases if residual disease is present in the mediastinum at resection. The median survival of 55 patients diagnosed with tracheobronchial recurrence before July 1988 was 3.7 weeks. After July 1988, there were 22 patients in whom tracheobronchial recurrence developed, 19 of whom were treated by neodymium:yttrium-aluminum-garnet laser under local anesthesia. Additional external radiotherapy was offered to 8 patients who responded to laser treatment and were in satisfactory condition. Four of these patients (21%) had complete tumor regression. Partial regression occurred in 7 patients (37%): 2 were treated by combined therapy and 5 by laser alone. Most tolerated the laser treatment well, but the procedure was abandoned in 6 patients because of smoke inhalation. A tracheoesophageal fistula developed in 2 patients. The median survival for the entire group was 7.4 weeks, with 3 long survivors who lived more than 1 year. The combined application of laser and external radiotherapy is effective for the treatment of tracheobronchial recurrences in patients with esophageal carcinoma.