WorldWideScience

Sample records for capecitabine initially concomitant

  1. Capecitabine

    Science.gov (United States)

    Xeloda® ... Capecitabine is used in combination with other medications to treat breast cancer that has come back after ... has not improved after treatment with other medications. Capecitabine is also used to treat colon or rectal ...

  2. Oxaliplatin and capecitabine concomitant with neoadjuvant radiotherapy and extended to the resting period in high risk locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Y.H.; Zeng, Z.F. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Radiation Oncology, Guangzhou (China); Zhang, X. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Thoracic Surgery, Guangzhou (China); An, X. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Medical Oncology, Guangzhou (China); Cai, M.Y. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Pathology, Guangzhou (China); Chen, G.; Kong, L.H.; Lin, J.Z.; Wan, D.S.; Pan, Z.Z.; Ding, P.R. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Colorectal Surgery, Guangzhou (China)

    2014-02-15

    Conventional neoadjuvant chemoradiotherapy (CRT) is suboptimal for systemic control in locally advanced rectal cancer (LARC). To improve systemic control, we developed an alternative approach in which an intensified oxaliplatin and capecitabine (XELOX) chemotherapy regimen was administered concomitantly with radiation and extended to the resting period (consolidation chemotherapy) for high-risk LARC. The aim of the current study was to evaluate the short-term efficacy and toxicity of this strategy. Patients with high-risk LARC were treated with CRT. Two cycles of XELOX were administered concomitantly with radiation. Thereafter, an additional cycle of the same regimen was administered during the resting period after completion of CRT. Tumor response, toxicities and surgical complications were recorded. This study includes 36 patients treated with the above strategy. All patients completed the planned concurrent CRT. Because of grade 3 toxicities, 2 patients were unable to complete the additional chemotherapy. Grade 3 toxicities were leucopenia (2.8 %), diarrhea (2.8 %) and radiodermatitis (2.8 %). All patients underwent optimal surgery with total mesorectal excision (TME) and a sphincter-saving procedure was performed in 27 patients (75 %). There was no perioperative mortality. Postoperative complications developed in 7 patients (19.4 %). Pathologic complete regression (pCR),''nearly pCR'' (major regression), and moderate or minimal regression were achieved in 13 (36.1 %), 16 (44.4 %), and 7 patients (19.5 %), respectively. The preliminary results suggest that a XELOX regimen initially administered concomitantly with radiotherapy and then extended to the resting period in high-risk LARC patients is well tolerated. The strategy is highly effective in terms of pCR and nearly pCR rates, and thus warrants further investigation. (orig.)

  3. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity

    International Nuclear Information System (INIS)

    Background: To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. Material and methods: From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. Results: Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. Discussion: Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease

  4. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, R. Charles Jr.; Huh, Soon; Ho, Meng Wei; Mendenhall, Nancy P.; Morris, Christopher G.; Hoppe, Bradford S. [Univ. of Florida Proton Therapy Inst., Jacksonville (United States)], e-mail: rnichols@floridaproton.org; George, Thomas J.; Zaiden, Robert A. Jr. [Dept. of Hematology and Medical Oncology, Univ. of Florida, Gainesville and Jacksonville (United States); Awad, Ziad T. [Dept. of Surgery, Univ. of Florida, Jacksonville (United States); Asbun, Horacio J. [Dept. of Surgery, Mayo Clinic, Jacksonville (United States)

    2013-04-15

    Background: To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. Material and methods: From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. Results: Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. Discussion: Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.

  5. Preoperative concomitant boost intensity-modulated radiotherapy with oral capecitabine in locally advanced mid-low rectal cancer: A phase II trial

    International Nuclear Information System (INIS)

    Purpose: We aimed to assess the safety and efficacy of preoperative intensity-modulated radiotherapy (IMRT) with oral capecitabine in patients with locally advanced mid-low rectal cancer using a concomitant boost technique. Materials and methods: Patients with resectable locally advanced mid-low rectal cancer (node-negative ⩾T3 or any node-positive tumor) were eligible. The eligible patients received IMRT to 2 dose levels simultaneously (50.6 and 41.8 Gy in 22 fractions) with concurrent capecitabine 825 mg/m2 twice daily 5 days/week. The primary end point included toxicity, postoperative complication, and pathological complete response rate (ypCR). The secondary endpoints included local recurrence rate, progression-free survival (PFS), and overall survival (OS). Results: Sixty-three eligible patients were enrolled; five patients did not undergo surgery. Of the 58 patients evaluable for pathologic response, the ypCR rate was 31.0% (95% CI 19.1–42.9). Grade 3 toxicities included diarrhea (9.5%), radiation dermatitis (3.2%), and neutropenia (1.6%). There was no Grade 4 toxicity reported. Four (6.9%) patients developed postoperative complications. Two-year local recurrence rate, PFS, and OS were 5.7%, 90.5%, and 96.0%, respectively. Conclusions: The design of preoperative concurrent boost IMRT with oral capecitabine could achieve high rate of ypCR with an acceptable toxicity profile.

  6. Simultaneous Integrated Boost–Intensity Modulated Radiation Therapy With Concomitant Capecitabine and Mitomycin C for Locally Advanced Anal Carcinoma: A Phase 1 Study

    Energy Technology Data Exchange (ETDEWEB)

    Deenen, Maarten J. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Dewit, Luc [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Boot, Henk [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Beijnen, Jos H. [Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Schellens, Jan H.M. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Cats, Annemieke, E-mail: a.cats@nki.nl [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

    2013-04-01

    Purpose: Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost–intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. Methods and Materials: Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m{sup 2} (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m{sup 2} b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). Results: A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m{sup 2} b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. Conclusions: SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m{sup 2} b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer.

  7. Simultaneous Integrated Boost–Intensity Modulated Radiation Therapy With Concomitant Capecitabine and Mitomycin C for Locally Advanced Anal Carcinoma: A Phase 1 Study

    International Nuclear Information System (INIS)

    Purpose: Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost–intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. Methods and Materials: Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m2 (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m2 b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). Results: A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m2 b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. Conclusions: SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m2 b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer

  8. Hypofractionated Image-Guided IMRT in Advanced Pancreatic Cancer With Simultaneous Integrated Boost to Infiltrated Vessels Concomitant With Capecitabine: A Phase I Study

    Energy Technology Data Exchange (ETDEWEB)

    Passoni, Paolo, E-mail: passoni.paolo@hsr.it [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy); Reni, Michele [Department of Medical Oncology, San Raffaele Scientific Institute, Milan (Italy); Cattaneo, Giovanni M. [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Slim, Najla [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy); Cereda, Stefano [Department of Medical Oncology, San Raffaele Scientific Institute, Milan (Italy); Balzano, Gianpaolo; Castoldi, Renato [Department of Surgery, San Raffaele Scientific Institute, Milan (Italy); Longobardi, Barbara [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Bettinardi, Valentino; Gianolli, Luigi [Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan (Italy); Gusmini, Simone [Department of Radiology, San Raffaele Scientific Institute, Milan (Italy); Staudacher, Carlo [Department of Surgery, San Raffaele Scientific Institute, Milan (Italy); Calandrino, Riccardo [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Di Muzio, Nadia [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy)

    2013-12-01

    Purpose: To determine the maximum tolerated radiation dose (MTD) of an integrated boost to the tumor subvolume infiltrating vessels, delivered simultaneously with radical dose to the whole tumor and concomitant capecitabine in patients with pretreated advanced pancreatic adenocarcinoma. Methods and Materials: Patients with stage III or IV pancreatic adenocarcinoma without progressive disease after induction chemotherapy were eligible. Patients underwent simulated contrast-enhanced four-dimensional computed tomography and fluorodeoxyglucose-labeled positron emission tomography. Gross tumor volume 1 (GTV1), the tumor, and GTV2, the tumor subvolume 1 cm around the infiltrated vessels, were contoured. GTVs were fused to generate Internal Target Volume (ITV)1 and ITV2. Biological tumor volume (BTV) was fused with ITV1 to create the BTV+Internal Target Volume (ITV) 1. A margin of 5/5/7 mm (7 mm in cranium-caudal) was added to BTV+ITV1 and to ITV2 to create Planning Target Volume (PTV) 1 and PTV2, respectively. Radiation therapy was delivered with tomotherapy. PTV1 received a fixed dose of 44.25 Gy in 15 fractions, and PTV2 received a dose escalation from 48 to 58 Gy as simultaneous integrated boost (SIB) in consecutive groups of at least 3 patients. Concomitant chemotherapy was capecitabine, 1250 mg/m{sup 2} daily. Dose-limiting toxicity (DLT) was defined as any treatment-related G3 nonhematological or G4 hematological toxicity occurring during the treatment or within 90 days from its completion. Results: From June 2005 to February 2010, 25 patients were enrolled. The dose escalation on the SIB was stopped at 58 Gy without reaching the MTD. One patient in the 2{sup nd} dose level (50 Gy) had a DLT: G3 acute gastric ulcer. Three patients had G3 late adverse effects associated with gastric and/or duodenal mucosal damage. All patients received the planned dose of radiation. Conclusions: A dose of 44.25 Gy in 15 fractions to the whole tumor with an SIB of 58 Gy to small

  9. Virtual facial expressions of emotions: An initial concomitant and construct validity study.

    OpenAIRE

    Christian eJoyal; Laurence eJacob; Marie-Hélène eCigna; Jean-Pierre eGuay; Patrice eRENAUD

    2014-01-01

    Abstract. Background. Facial expressions of emotions represent classic stimuli for the study of social cognition. Developing virtual dynamic facial expressions of emotions, however, would open-up possibilities, both for fundamental and clinical research. For instance, virtual faces allow real-time Human-Computer retroactions between physiological measures and the virtual agent. Objectives. The goal of this study was to initially assess concomitant and construct validity of a newly developed s...

  10. Comparison of two preoperative chemoradiotherapy regimens for locally advanced rectal cancer: capecitabine alone versus capecitabine plus irinotecan

    International Nuclear Information System (INIS)

    To compare the short-term tumor response and long-term clinical outcome of two preoperative chemoradiotherapy (CRT) regimens for locally advanced rectal cancer. This study included 231 patients scheduled for preoperative CRT using two chemotherapeutic protocols from April 2003–August 2006. Pelvic radiotherapy (50.4 Gy) was delivered concurrently with capecitabine (n = 148) or capecitabine/irinotecan (n = 83). Surgery was performed 4–8 weeks after CRT completion. Tumor responses to CRT were assessed using both radiologic and pathologic measurements. Radiologic responses were evaluated by magnetic resonance volumetry, which was performed at the initial work-up and after completion of preoperative CRT just before surgery. Pathologic responses were assessed with downstaging (ypStage 0-1) and grading tumor regression. Clinical outcomes were evaluated in terms of local control, relapse-free survival, and overall survival rates. Radiologic examination demonstrated that tumor volume decreased by 65.6% in the capecitabine group and 66.8% capecitabine/irinotecan group (p = 0.731). Postoperative pathologic stage determination showed that tumor downstaging occurred in 44.1% of the capecitabine group and 48.6% of the capecitabine/irinotecan group (p = 0.538). The sum of tumor regression grade 3 (near complete response) and 4 (complete response) after CRT were 28.6% in the capecitabine group and 37.5% in the capecitabine/irinotecan group (p = 0.247). There were no significant differences between the two groups in 5-year local control (91.7% vs. 92.5%; p = 0.875), relapse-free survival (80.8% vs. 77.2%; p = 0.685), and overall survival (88.4% vs. 90.4%; p = 0.723). This study revealed no differences in the short-term tumor response and long-term clinical outcome between preoperative capecitabine and capecitabine/irinotecan CRT regimens for locally advanced rectal cancer

  11. Preoperative treatment with capecitabine, cetuximab and radiotherapy for primary locally advanced rectal cancer : A phase II clinical trial

    NARCIS (Netherlands)

    Eisterer, Wolfgang; de Vries, Alexander; Öfner, Dietmar; Rabl, Hans; Koplmüller, Renate; Greil, Richard; Tschmelitsch, Jöerg; Schmid, Rainer; Kapp, Karin; Lukas, Peter; Sedlmayer, Felix; Höfler, Gerald; Gnant, Michael; Thaler, Josef; Widder, Joachim

    2014-01-01

    BACKGROUND/AIM: To investigate the feasibility and safety of preoperative capecitabine, cetuximab and radiation in patients with MRI-defined locally advanced rectal cancer (LARC, cT3/T4). PATIENTS AND METHODS: 31 patients with LARC were treated with cetuximab and capecitabine concomitantly with 45 G

  12. Concomitant Guillain Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary

    Science.gov (United States)

    Singh, Diwakar Kumar

    2016-01-01

    Neuropsychiatric manifestations of systemic lupus erythematosus are varied. Presently nineteen in number, they are classified as whether affecting the central or the peripheral compartments of the nervous system. Its diagnosis however remains difficult, more so when two or more of the syndromes are found concomitantly in the same patient and when they occur in absence of the more classical rash, serositis, and haematological manifestations. We present a case of lupus where myelopathy as well as demyelination existed simultaneously as the initial neurologic manifestation. PMID:27242943

  13. Concomitant Guillain Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary.

    Science.gov (United States)

    Srivastava, Anshuman; Kundu, Bijit Kumar; Singh, Diwakar Kumar

    2016-01-01

    Neuropsychiatric manifestations of systemic lupus erythematosus are varied. Presently nineteen in number, they are classified as whether affecting the central or the peripheral compartments of the nervous system. Its diagnosis however remains difficult, more so when two or more of the syndromes are found concomitantly in the same patient and when they occur in absence of the more classical rash, serositis, and haematological manifestations. We present a case of lupus where myelopathy as well as demyelination existed simultaneously as the initial neurologic manifestation. PMID:27242943

  14. Concomitant chemoradiotherapy with CDDP and 5FU for nasopharyngeal carcinoma. The initial evaluation and side effects

    International Nuclear Information System (INIS)

    Concomitant chemoradiotherapy with CDDP and 5FU was given to 18 patients with nasopharyngeal carcinoma during January 1994-October 1996. One and 17 were in Stages III-IV respectively. None had distant metastasis. The median duration of follow-up of all patients was 23.5 months (6-45). Objective response (CR+PR) of the primary lesion and the regional nodes was 18/18 (100%), whereas CR was 2/18 (11%). CR+PR and CR at the primary lesion were 18/18 (100%) and 5/18 (28%) respectively. Two patients died of disease at T site. One patient was alive with disease. The remaining 15 (83%) patients were relapse free alive. There were 2 relapses, 1 at T+M, and 1 at T+N sites. Side effects, especially myelosuppression and mucositis, were severe. Leukopenia and mucositis in grade 3-4 were 78% and 89% respectively. In conclusion, this regimen has been effective in short term follow-up. However, because of severe side effects, further modifications are required. Long term follow-up are required to define final effectiveness of this regimen. (author)

  15. Coagulopathy as initial manifestation of concomitant celiac disease and cystic fibrosis: a case report

    Directory of Open Access Journals (Sweden)

    Zdraveska Nikolina

    2011-03-01

    Full Text Available Abstract Introduction Celiac disease and cystic fibrosis have many common manifestations, such as malabsorption, steatorrhea and growth failure, and were for many years recognized as one clinical entity. Since their recognition as two separate diseases, their co-existence in a patient has been described sporadically; around 20 cases have been described in the literature. Taking into consideration the incidences of the two diseases, the chance of them occurring together is one in 2,000,000 in the general population. Case presentation We describe the case of a five-year-old boy of Turkish ethnicity with both celiac disease and cystic fibrosis, who presented initially with a skin hemorrhage. The diagnosis of celiac disease was made with a positive serum anti-tissue transglutaminase antibody test and the presence of HLA-DQ2 heterodimer, and confirmed on histology with small intestinal villous atrophy. A positive sweat test confirmed the diagnosis of associated cystic fibrosis. To the best of our knowledge there has been no previous report of this rare presentation of associated celiac disease and cystic fibrosis. Conclusion The clinical significance of this case is the consideration of malabsorption with both celiac disease and cystic fibrosis in patients who present with unexplained coagulopathy.

  16. Concomitant Guillain Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary

    OpenAIRE

    Anshuman Srivastava; Bijit Kumar Kundu; Diwakar Kumar Singh

    2016-01-01

    Neuropsychiatric manifestations of systemic lupus erythematosus are varied. Presently nineteen in number, they are classified as whether affecting the central or the peripheral compartments of the nervous system. Its diagnosis however remains difficult, more so when two or more of the syndromes are found concomitantly in the same patient and when they occur in absence of the more classical rash, serositis, and haematological manifestations. We present a case of lupus where myelopathy as well ...

  17. An adverse interaction between warfarin and capecitabine: a case report and review of the literature.

    Science.gov (United States)

    Copur, M S; Ledakis, P; Bolton, M; Morse, A K; Werner, T; Norvell, M; Muhvic, J; Chu, E

    2001-11-01

    Warfarin is one of the most commonly used oral anticoagulants in the clinic. It is well established that a wide range of antineoplastic drugs interact with warfarin, resulting in altered coagulation parameters and/or bleeding sequelae. While altered coagulation parameters have been observed in patients taking the oral 5-fluorouracil prodrug, capecitabine, in combination with warfarin, no report to date has described clinically overt evidence of bleeding. Herein, we report 2 cancer patients who presented with bleeding episodes that most likely resulted from an adverse interaction between capecitabine and warfarin after 6 weeks of concomitant therapy. In each case, there was a marked elevation in both the prothrombin time and international normalized ratio (> 10), with subsequent gastrointestinal bleeding. The exact mechanism of this interaction is yet unknown, but it is possible that capecitabine might, in some manner, reduce the hepatic metabolism of warfarin. Close monitoring of coagulation parameters is recommended for all patients receiving concomitant warfarin and capecitabine, with appropriate adjustment of warfarin dosage. The nature and extent of this interaction requires further investigation. PMID:12450435

  18. Hypokalemia secondary to capecitabine: a hidden toxicity?

    OpenAIRE

    Saif, Muhammad Wasif; Fekrazad, Mohammad Houman; Ledbetter, Leslie; Diasio, Robert B

    2007-01-01

    Background Hyopkalemia is a listed toxicity in the capecitabine (Xeloda®; Roche, Nutley, NJ) package insert. However, the incidence and severity of this toxicity is not known. Methods We performed a retrospective evaluation of hypokalemia in 77 patients, who received capecitabine for gastrointestinal malignancies between April 2002 and November 2004. Hypokalemia was defined as K+ level

  19. Chemoradiation of Hepatic Malignancies: Prospective, Phase 1 Study of Full-Dose Capecitabine With Escalating Doses of Yttrium-90 Radioembolization

    International Nuclear Information System (INIS)

    Purpose: Radiosensitizing chemotherapy improves the outcomes in comparison with radiation alone for gastrointestinal cancers. The delivery of radiation therapy with yttrium90 (90Y) radioembolization, in combination with the radiosensitizing chemotherapeutic agent capecitabine, provides the opportunity to enhance the effects of radiation on hepatic malignancies. This phase 1 study sought to determine the maximum tolerated dose (MTD) of 90Y plus capecitabine in patients with cholangiocarcinoma or liver metastases confined to the liver. Methods and Materials: Patients were given initial treatment at full-dose capecitabine during days 1 to 14 of a 21-day cycle. At days 1 to 7 of the second cycle, whole-liver 90Y was given at the test dose, after which time capecitabine was continued. Dose-limiting toxicity (DLT) was determined 6 weeks after 90Y infusion. If a DLT was not observed, the 90Y dose was escalated. The planned dose cohorts were 110, 130, 150, and 170 Gy. The primary endpoint was to determine the MTD of 90Y with full-dose capecitabine. Results: Sixteen patients were treated according to the study protocol. Two patients experienced DLTs. Nine patients required capecitabine dose reduction as a result of toxicities attributable to capecitabine alone. The criteria for establishing 90Y MTD were not met, indicating an MTD of >170 Gy. Conclusion: The MTD of 90Y delivered in conjunction with capecitabine in the setting of intrahepatic cholangiocarcinoma or metastatic disease confined to the liver exceeds 170 Gy. This is the highest 90Y dose reported to date and has important implications on combined therapy with the radiosensitizing oral chemotherapeutic capecitabine. Further studies are under way

  20. Chemoradiation of Hepatic Malignancies: Prospective, Phase 1 Study of Full-Dose Capecitabine With Escalating Doses of Yttrium-90 Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Hickey, Ryan [Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Mulcahy, Mary F. [Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois (United States); Lewandowski, Robert J.; Gates, Vanessa L.; Vouche, Michael; Habib, Ali [Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Kircher, Sheetal; Newman, Steven; Nimeiri, Halla; Benson, Al B. [Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois (United States); Salem, Riad, E-mail: r-salem@northwestern.edu [Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois (United States)

    2014-04-01

    Purpose: Radiosensitizing chemotherapy improves the outcomes in comparison with radiation alone for gastrointestinal cancers. The delivery of radiation therapy with yttrium90 ({sup 90}Y) radioembolization, in combination with the radiosensitizing chemotherapeutic agent capecitabine, provides the opportunity to enhance the effects of radiation on hepatic malignancies. This phase 1 study sought to determine the maximum tolerated dose (MTD) of {sup 90}Y plus capecitabine in patients with cholangiocarcinoma or liver metastases confined to the liver. Methods and Materials: Patients were given initial treatment at full-dose capecitabine during days 1 to 14 of a 21-day cycle. At days 1 to 7 of the second cycle, whole-liver {sup 90}Y was given at the test dose, after which time capecitabine was continued. Dose-limiting toxicity (DLT) was determined 6 weeks after {sup 90}Y infusion. If a DLT was not observed, the {sup 90}Y dose was escalated. The planned dose cohorts were 110, 130, 150, and 170 Gy. The primary endpoint was to determine the MTD of {sup 90}Y with full-dose capecitabine. Results: Sixteen patients were treated according to the study protocol. Two patients experienced DLTs. Nine patients required capecitabine dose reduction as a result of toxicities attributable to capecitabine alone. The criteria for establishing {sup 90}Y MTD were not met, indicating an MTD of >170 Gy. Conclusion: The MTD of {sup 90}Y delivered in conjunction with capecitabine in the setting of intrahepatic cholangiocarcinoma or metastatic disease confined to the liver exceeds 170 Gy. This is the highest {sup 90}Y dose reported to date and has important implications on combined therapy with the radiosensitizing oral chemotherapeutic capecitabine. Further studies are under way.

  1. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Purpose: Capecitabine (Xeloda) is a new orally administered fluoropyrimidine carbamate that was rationally designed to exert its effect by tumor-selective activation. We attempted to evaluate the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced rectal cancer. Methods and Materials: Between July 1999 and March 2001, 45 patients with locally advanced rectal cancer (cT3/T4 or N+) were treated with preoperative chemoradiation. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrent with radiotherapy and consisted of 2 cycles of 14-day oral capecitabine (1650 mg/m2/day) and leucovorin (20 mg/m2/day), each of which was followed by a 7-day rest period. Surgery was performed 6 weeks after the completion of chemoradiation. Results: Thirty-eight patients received definitive surgery. Primary tumor and node downstaging occurred in 63% and 90% of patients, respectively. The overall downstaging rate, including both primary tumor and nodes, was 84%. A pathologic complete response was achieved in 31% of patients. Twenty-one patients had tumors located initially 5 cm or less from the anal verge; among the 18 treated with surgery, 72% received sphincter-preserving surgery. No Grade 3 or 4 hematologic toxicities developed. Other Grade 3 toxicities were as follows: hand-foot syndrome (7%), fatigue (4%), diarrhea (4%), and radiation dermatitis (2%). Conclusion: These preliminary results suggest that preoperative chemoradiation with capecitabine is a safe, well-tolerated, and effective neoadjuvant treatment modality for locally advanced rectal cancer. In addition, this preoperative treatment has a considerable downstaging effect on the tumor and can increase the possibility of sphincter preservation in distal rectal cancer

  2. Capecitabine in the management of colorectal cancer

    OpenAIRE

    Hirsch BR; Zafar SY

    2011-01-01

    Bradford R Hirsch, S Yousuf ZafarDivision of Medical Oncology, Duke University Medical Center, Durham, NC, USAAbstract: 5-Fluorouracil has been a mainstay in the treatment of colorectal cancer for nearly five decades; however, the use of oral formulations of the medication has been gaining increasing traction since capecitabine was approved for use in adjuvant settings by the US Food and Drug Administration in 2005. The use of capecitabine has since spread to a number of off-label indications...

  3. Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Si, W. [General Hospital of the Chinese People' s Liberation Army, Department of Medical Oncology, Haidian District, Beijing, China, Department of Medical Oncology, General Hospital of the Chinese People’s Liberation Army, Haidian District, Beijing (China); School of Medicine, Nankai University, Tianjin (China); Zhu, Y.Y.; Li, Y.; Gao, P.; Han, C.; You, J.H.; Linghu, R.X.; Jiao, S.C.; Yang, J.L. [General Hospital of the Chinese People' s Liberation Army, Department of Medical Oncology, Haidian District, Beijing, China, Department of Medical Oncology, General Hospital of the Chinese People’s Liberation Army, Haidian District, Beijing (China)

    2013-11-25

    Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT) after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT) maintenance therapy. We compared time to progression (TTP), objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45); the median TTP (MTTP) for the complete treatment was 9.43 months (95%CI=8.38-10.48 months) for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004) for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months) for the CMT group and 2.0 months (95%CI=1.63-2.38 months) for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile.

  4. Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

    Directory of Open Access Journals (Sweden)

    W. Si

    2013-12-01

    Full Text Available Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT maintenance therapy. We compared time to progression (TTP, objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45; the median TTP (MTTP for the complete treatment was 9.43 months (95%CI=8.38-10.48 months for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004 for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months for the CMT group and 2.0 months (95%CI=1.63-2.38 months for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile.

  5. Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

    International Nuclear Information System (INIS)

    Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT) after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT) maintenance therapy. We compared time to progression (TTP), objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45); the median TTP (MTTP) for the complete treatment was 9.43 months (95%CI=8.38-10.48 months) for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004) for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months) for the CMT group and 2.0 months (95%CI=1.63-2.38 months) for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile

  6. Adverse Interaction between Capecitabine and Warfarin Resulting in Altered Coagulation Parameters: A Review of the Literature Starting from a Case Report

    Directory of Open Access Journals (Sweden)

    Giovanni Giunta

    2010-01-01

    Full Text Available Capecitabine is an orally active prodrug of fluorouracil and is extensively used as an antineoplastic agent. It is converted to 5-Fluorouracil in the liver and tumor tissues. Warfarin is an anticoagulant agent for preventing and treating venous and arterial thrombosis and embolism and is metabolized by cytochrome P450 isoenzymes in the liver. Preclinical in vitro studies using human liver microsomes report no inhibitory effects between capecitabine and substrates of cytochrome P. However, the concomitant administration of capecitabine and warfarin resulted in INR elevation in the cases previously reported in the literature. The exact mechanism of this interaction is unknown but may be related to downregulation of cytochrome P450 2C9 by capecitabine or its metabolites. We report on the possible adverse interaction between capecitabine and warfarin in a patient with metastatic breast cancer and critically review the existing literature on this topic. Physicians should be aware of adverse reactions arising from the combined use of capecitabine and warfarin. In the light of the current data, INR levels should be closely monitored in patients using these drugs together.

  7. Capecitabine induced hypertriglyceridaemia: An underreported and potentially severe side effect

    Directory of Open Access Journals (Sweden)

    Tabchi S

    2014-05-01

    Full Text Available A 57 year-old-woman, with no previous history of dyslipedemia, developed severe hypertriglyceridemia while being treated with capecitabine for metastatic breast cancer. Capecitabine was not discontinued and serum triglyceride levels were normalized after 4 weeks of treatment with fenofibrate. Capecitabine induced hypertriglyceridemia, as a rare drug-related side effect, seems to be often overlooked by clinicians.

  8. Capecitabine cardiac toxicity presenting as effort angina: a case report.

    Science.gov (United States)

    Lestuzzi, Chiara; Crivellari, Diana; Rigo, Fausto; Viel, Elda; Meneguzzo, Nereo

    2010-09-01

    We report a case of capecitabine-induced cardiotoxicity (effort angina) in a woman with metastatic breast carcinoma. Due to cancer progression, rechallenge of therapy with capecitabine was attempted, using several strategies in order to prevent cardiotoxicity. The most (even if not fully) effective strategy was reducing capecitabine dosage together with nitrates, calcium-channel blockers and trimetazidine therapy. PMID:20093950

  9. Capecitabine in the management of colorectal cancer

    Directory of Open Access Journals (Sweden)

    Hirsch BR

    2011-03-01

    Full Text Available Bradford R Hirsch, S Yousuf ZafarDivision of Medical Oncology, Duke University Medical Center, Durham, NC, USAAbstract: 5-Fluorouracil has been a mainstay in the treatment of colorectal cancer for nearly five decades; however, the use of oral formulations of the medication has been gaining increasing traction since capecitabine was approved for use in adjuvant settings by the US Food and Drug Administration in 2005. The use of capecitabine has since spread to a number of off-label indications, including the treatment of advanced or metastatic colorectal cancer and the neoadjuvant treatment of rectal cancer. In light of increasing utilization, it is critical that clinicians have a firm understanding of the literature supporting capecitabine across various settings as well as the attributes of the drug, such as its dosing recommendations, side-effect profile, and use in the elderly. The purpose of this review is to synthesize the literature in a fashion that can be used to help guide decisions. In a setting of increasing focus on cost, the pharmacoeconomic literature is also briefly reviewed.Keywords: colon cancer, colorectal cancer, rectal cancer, capecitabine, Xeloda

  10. Use of capecitabine in management of early colon cancer

    OpenAIRE

    Cassidy J; Hameed H

    2011-01-01

    H Hameed, J CassidyBeatson West of Scotland Cancer Centre, Glasgow, Scotland, UKAbstract: Capecitabine (Xeloda®, Roche, Basel, Switzerland) is a pro-drug of 5-fluorouracil (5-FU), and it is converted to 5-FU in the cancer cell by enzymatic degradation. The role of capecitabine in colorectal cancer has evolved in the last 15 years. In early trials in the metastatic setting, capecitabine has shown superior response rates compared with those achieved with 5-FU (Mayo Clinic regimen) (26% ...

  11. Oromandibular dystonia: A serious side effect of capecitabine

    NARCIS (Netherlands)

    M.J.M. van Pelt-Sprangers (Melanie J.M.); E.C.T. Geijteman (Eric); J. Alsma (Jelmer); I.A. Boere (Ingrid); A.H.J. Mathijssen (Ron); S.C.E. Schuit (Stephanie)

    2015-01-01

    textabstractBackground: Capecitabine has activity against several types of cancer. In 10-15% of patients treated with capecitabine, treatment is discontinued because of serious adverse reactions, mostly within the first weeks of treatment. Case presentation: A 56 year-old female patient presented at

  12. A comparison between 5-fluorouracil/mitomycin and capecitabine/mitomycin in combination with radiation for anal cancer

    Science.gov (United States)

    Wan, Dante D.; Schellenberg, Devin; Lim, Howard J.

    2016-01-01

    Background There are no randomized phase III trials comparing 5-fluorouracil/mitomycin (FM) versus capecitabine/mitomycin (CM) in combination with radiotherapy (RT) for locally advanced anal cancer. We aim to evaluate the outcomes of patients treated with FM and CM at our institution. Methods Patients with stage I–III anal cancer who initiated curative-intent RT (50–54 Gy) with either CM or FM between 1998 and 2013 at the BC Cancer Agency were reviewed. Cox proportional models were used to analyze the impact of regimen on disease-free survival (DFS) and anal cancer-specific survival (ACSS). Results A total of 300 patients were included. Baseline characteristics were well-distributed between the groups. A total of 194 patients (64.6%) received FM and 106 (35.3%) CM. The 2-year DFS was 79.7% for CM [95% confidence intervals (95% CI), 71.1–88.3%] and 78.8% for FM (95% CI, 73–84.6%); 2-year ACSS was 88.7% for CM (95% CI, 81.8–95.5%) and 87.5% for FM (95% CI, 82.8–92.2%). On multivariate analysis, only HIV status, clinical T size (≤5 vs. >5 cm), and N status (negative vs. positive) remained as significant prognostic factors for both DFS and ACSS. Chemotherapy regimen (CM vs. FM) had no impact on either DFS [P=0.995; hazard ratios (HR) =0.99; 95% CI, 0.57–1.74] or ACSS (P=0.847; HR =0.93; 95% CI, 0.46–1.86). Conclusions In our population-based study, CM and FM concomitant with RT achieved similar DFS and ACSS. Substitution of capecitabine for infusional 5-FU may therefore be a reasonable option for patients and physicians who prefer to avoid the inconvenience and potential complications of a central infusional device. PMID:27563458

  13. Vorinostat synergises with capecitabine through upregulation of thymidine phosphorylase

    Science.gov (United States)

    Di Gennaro, E; Piro, G; Chianese, M I; Franco, R; Cintio, A Di; Moccia, T; Luciano, A; de Ruggiero, I; Bruzzese, F; Avallone, A; Arra, C; Budillon, A

    2010-01-01

    Background: Potentiation of anticancer activity of capecitabine is required to improve its therapeutic index. In colorectal cancer (CRC) cells, we evaluated whether the histone deacetylase-inhibitor vorinostat may induce synergistic antitumour effects in combination with capecitabine by modulating the expression of thymidine phosphorylase (TP), a key enzyme in the conversion of capecitabine to 5-florouracil (5-FU), and thymidylate synthase (TS), the target of 5-FU. Methods: Expression of TP and TS was measured by real-time PCR, western blotting and immunohistochemistry. Knockdown of TP was performed by specific small interfering RNA. Antitumour activity of vorinostat was assessed in vitro in combination with the capecitabine active metabolite deoxy-5-fluorouridine (5′-DFUR) according to the Chou and Talay method and by evaluating apoptosis as well as in xenografts-bearing nude mice in combination with capecitabine. Results: Vorinostat induced both in vitro and in vivo upregulation of TP as well as downregulation of TS in cancer cells, but not in ex vivo treated peripheral blood lymphocytes. Combined treatment with vorinostat and 5′-DFUR resulted in a synergistic antiproliferative effect and increased apoptotic cell death in vitro. This latter effect was impaired in cells where TP was knocked. In vivo, vorinostat plus capecitabine potently inhibited tumour growth, increased apoptosis and prolonged survival compared with control or single-agent treatments. Conclusions: Overall, this study suggests that the combination of vorinostat and capecitabine is an innovative antitumour strategy and warrants further clinical evaluation for the treatment of CRC. PMID:21045833

  14. Weekly Paclitaxel plus Capecitabine versus Docetaxel Every 3 Weeks plus Capecitabine in Metastatic Breast Cancer

    Directory of Open Access Journals (Sweden)

    E. A. Wist

    2012-01-01

    Full Text Available Background. We performed a randomized phase II study comparing efficacy and toxicity of weekly paclitaxel 80 mg/m2 (Weetax with three weekly docetaxel 75 mg/m2 (Threetax, both in combination with oral capecitabine 1000 mg/m2 twice daily for 2 weeks followed by a 1-week break. Patients. Thirty-seven women with confirmed metastatic breast cancer were randomized. Results. Median TTF was 174 (Weetax versus 147 days (Threetax (=0.472. Median OS was 933 (Weetax versus 464 days (Threetax (=0.191. Reasons for TTF were PD 8/18 (Weetax, 9/19 (Threetax; and toxicity: 8/18 (Weetax, 8/19 (Threetax. ORR was 72% (Weetax versus 26% (Threetax (=0.01. The Threetax-combination resulted in a higher incidence of leuco-/neutropenia compared to Weetax. Grade II anemia was more pronounced in the Weetax group. No difference was found in quality of life. Conclusion. Taxanes in combination with capecitabine resulted in a high level of toxicity. Taxanes and capecitabine should be considered given sequentially and not in combination.

  15. Capecitabine for locally advanced and metastatic colorectal cancer: A review

    OpenAIRE

    Koukourakis, Georgios V; Zacharias, Georgios; Tsalafoutas, John; Theodoridis, Dimitrios; Kouloulias, Vassilios

    2010-01-01

    Capecitabine (Xeloda®) is an oral fluoropyrimidine which is produced as a pro-drug of fluorouracil, and shows improved tolerability and intratumor drug concentrations following its tumor-specific conversion to the active drug. We have searched the Pubmed and Cochrane databases from 1980 to 2009 with the purpose of reviewing all available information on Capecitabine, focusing on its clinical effectiveness against colorectal cancer. Special attention has been paid to trials that compared Capeci...

  16. Use of capecitabine in management of early colon cancer

    Directory of Open Access Journals (Sweden)

    Cassidy J

    2011-08-01

    Full Text Available H Hameed, J CassidyBeatson West of Scotland Cancer Centre, Glasgow, Scotland, UKAbstract: Capecitabine (Xeloda®, Roche, Basel, Switzerland is a pro-drug of 5-fluorouracil (5-FU, and it is converted to 5-FU in the cancer cell by enzymatic degradation. The role of capecitabine in colorectal cancer has evolved in the last 15 years. In early trials in the metastatic setting, capecitabine has shown superior response rates compared with those achieved with 5-FU (Mayo Clinic regimen (26% vs 17%, with equivalent progression-free survival and overall survival. In the adjuvant setting, the Xeloda in Adjuvant Colon Cancer Therapy (X-ACT trial demonstrated that capecitabine as a single agent led to improvement in relapse-free survival (hazard ratio: 0.86, 95% confidence interval: 0.74–0.99, P = 0.04 and was associated with significantly fewer adverse events than 5-FU plus leucovorin (LV, folinic acid. On the basis of the X-ACT trial, capecitabine was approved by the United States Food and Drug Administration, the National Institute for Clinical Excellence, and the Scottish Medicines Consortium as monotherapy for the adjuvant treatment of stage III colon cancer. The next step was to incorporate capecitabine into combination therapy. The XELOXA trial studied the combination of capecitabine and oxaliplatin (XELOX vs 5-FU/LV and demonstrated 5-year disease-free survival of 66% for XELOX, compared with 60% for 5-FU/LV. The toxicity profile was also quite comparable in the two arms. So both the single agent use of capecitabine as well as in combination with oxaliplatin can be considered as part of the standard of care in management of early colon cancer in appropriately selected patient groups.Keywords: 5-fluorouracil, 5-FU, leucovorin, folinic acid, LV, XELOX, oxaliplatin, FOLFOX

  17. Targeting cancers in the gastrointestinal tract: role of capecitabine

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2009-03-01

    Full Text Available Muhammad Wasif SaifYale Cancer Center, Yale University School of Medicine, New Haven, CT, USAAbstract: Capecitabine is currently the only novel, orally home-administered fluorouracil prodrug. It offers patients more freedom from hospital visits and less inconvenience and complications associated with infusion devices. The drug has been extensively studied in large clinical trials in many solid tumors, including breast cancer, colorectal cancer, gastric cancer, and many others. Furthermore, the drug compares favorably with fluorouracil in patients with such cancers, with a safe toxicity profile, consisting mainly of gastrointestinal and dermatologic adverse effects. Whereas gastrointestinal events and hand-foot syndrome occur often with capecitabine, the tolerability profile is comparatively favorable. Prompt recognition of severe adverse effects is the key to successful management of capecitabine. Ongoing and future clinical trials will continue to examine, and likely expand, the role of capecitabine as a single agent and/or in combination with other anticancer agents for the treatment of gastrointestinal as well as other solid tumors, both in the advanced palliative and adjuvant settings. The author summarizes the current data on the role of capecitabine in the management of gastrointestinal cancers. Keywords: 5-fluorouracil, capecitabine, chemotherapy, adjuvant, advanced, colon cancer, gastric cancer, hepatocellular cancer, pancreatic cancer, cholangiocarcinoma, rectal cancer, anal cancer

  18. Capecitabine-induced ventricular fibrillation arrest: Possible Kounis syndrome.

    Science.gov (United States)

    Kido, Kazuhiko; Adams, Val R; Morehead, Richard S; Flannery, Alexander H

    2016-04-01

    We report the case of capecitabine-induced ventricular fibrillation arrest, possibly secondary to type I Kounis syndrome. A 47-year-old man with a history of T3N1 moderately differentiated adenocarcinoma of the colon, status-post sigmoid resection, was started on adjuvant capecitabine approximately five months prior to presentation of cardiac arrest secondary to ventricular fibrillation. An electrocardiogram (EKG) revealed ST segment elevation on the lateral leads and the patient was taken emergently to the cardiac catheterization laboratory. The catheterization revealed no angiographically significant stenosis and coronary artery disease was ruled out. After ruling out other causes of cardiac arrest, the working diagnosis was capecitabine-induced ventricular fibrillation arrest. As such, an inflammatory work up was sent to evaluate for the possibility of a capecitabine hypersensitivity, or Kounis syndrome, and is the first documented report in the literature to do so when evaluating Kounis syndrome. Immunoglobulin E (IgE), tryptase, and C-reactive protein were normal but histamine, interleukin (IL)-6, and IL-10 were elevated. Histamine elevation supports the suspicion that our patient had type I Kounis syndrome. Naranjo adverse drug reaction probability scale indicates a probable adverse effect due to capecitabine with seven points. A case of capecitabine-induced ventricular fibrillation arrest is reported, with a potential for type 1 Kounis syndrome as an underlying pathology supported by immunologic work up. PMID:25870182

  19. Hepatic steatosis secondary to capecitabine: a case report

    Directory of Open Access Journals (Sweden)

    Siu Lillian L

    2010-07-01

    Full Text Available Abstract Introduction There are no known case reports of hepatic steatosis caused by oral fluoropyrimidines such as capecitabine. With increasing use of capecitabine since its approval for the treatment of metastatic colon cancer in 2001, and more recently for adjuvant treatment of colon cancer and treatment of metastatic breast cancer, we can anticipate increased recognition of potential toxicities associated with this 5-fluorouracil derivative. Case presentation We report the case of a 74-year-old Armenian woman who received capecitabine as adjuvant treatment for colon cancer and subsequently developed abnormal liver biochemical tests and radiographic findings in keeping with hepatic steatosis. There was complete reversal of liver enzyme abnormalities with discontinuation of the drug and this patient represents a case of reversible liver injury due to capecitabine. Conclusion In this original case report, capecitabine use was associated with hepatic steatosis. It is important for clinicians to recognize and monitor for this potential toxicity, which may be a cause of abnormal liver enzymes in this patient population.

  20. Concurrent capecitabine and upper abdominal radiation therapy is well tolerated

    Directory of Open Access Journals (Sweden)

    Delclos Marc E

    2006-10-01

    Full Text Available Abstract We retrospectively evaluated acute toxicity in 88 patients that were treated with capecitabine and concurrent radiotherapy to the upper abdomen. These patients included 28 (32% with pancreatic adenocarcinoma, 18 (20% with cholangiocarcinoma, 11 (13% with ampullary carcinoma, 11 (13% with other primary tumors, 14 (16% with liver metastases, and 6 (7% with metastases at other sites. The median dose of radiotherapy was 45 Gy (range 30–72 Gy. The median dose of capecitabine was 850 mg/m2 twice daily, with 77% receiving 800–900 mg/m2 twice daily. The highest grade of acute toxicity was Common Terminology Criteria (CTC grade 0 in 5 (6%, grade 1 in 60 (68%, grade 2 in 18 (20%, and grade 3 in 5 (6% patients. No patient had CTC grade 4 toxicity. The most common grade 2 toxicities were nausea, hand-foot syndrome, fatigue, anorexia and diarrhea. The grade 3 toxicities included nausea, vomiting and fatigue. Three patients (3% required hospitalization due to grade 3 acute toxicity. Capecitabine was interrupted, discontinued or given at an adjusted dose in 13 (15% patients because of acute toxicity. Therefore, capecitabine and concurrent radiotherapy to the upper abdomen appears to be well tolerated. Capecitabine may serve as an alternative to bolus or infusional 5-FU during chemoradiation for upper gastrointestinal malignancies.

  1. Concurrent capecitabine and upper abdominal radiation therapy is well tolerated

    International Nuclear Information System (INIS)

    We retrospectively evaluated acute toxicity in 88 patients that were treated with capecitabine and concurrent radiotherapy to the upper abdomen. These patients included 28 (32%) with pancreatic adenocarcinoma, 18 (20%) with cholangiocarcinoma, 11 (13%) with ampullary carcinoma, 11 (13%) with other primary tumors, 14 (16%) with liver metastases, and 6 (7%) with metastases at other sites. The median dose of radiotherapy was 45 Gy (range 30–72 Gy). The median dose of capecitabine was 850 mg/m2 twice daily, with 77% receiving 800–900 mg/m2 twice daily. The highest grade of acute toxicity was Common Terminology Criteria (CTC) grade 0 in 5 (6%), grade 1 in 60 (68%), grade 2 in 18 (20%), and grade 3 in 5 (6%) patients. No patient had CTC grade 4 toxicity. The most common grade 2 toxicities were nausea, hand-foot syndrome, fatigue, anorexia and diarrhea. The grade 3 toxicities included nausea, vomiting and fatigue. Three patients (3%) required hospitalization due to grade 3 acute toxicity. Capecitabine was interrupted, discontinued or given at an adjusted dose in 13 (15%) patients because of acute toxicity. Therefore, capecitabine and concurrent radiotherapy to the upper abdomen appears to be well tolerated. Capecitabine may serve as an alternative to bolus or infusional 5-FU during chemoradiation for upper gastrointestinal malignancies

  2. [A Case of Colon Cancer with Multiple Liver Metastases Successfully Treated with Capecitabine/Oxaliplatin plus Bevacizumab].

    Science.gov (United States)

    Suematsu, Yuki; Ishibashi, Yuji; Hiratsuka, Miyuki; Suda, Hiroshi; Takahashi, Miyuki; Saito, Hiroyuki; Omori, Keita; Morita, Akihiko; Wakabayashi, Kazuhiko; Ito, Yutaka

    2015-11-01

    A 69-year-old woman was diagnosed with descending colon cancer with multiple liver metastases, and a left hemicolectomy was performed. The patient was treated with capecitabine/oxaliplatin (CapeOX) plus bevacizumab (Bmab). After 5 courses of chemotherapy, the number and size of liver metastases remarkably reduced, and after the 12th course, because of peripheral neuropathy, a "stop-and-go"fashion of administering oxaliplatin (L-OHP) was initiated. After 14 courses, the liver metastases had disappeared. After the 33rd course of L-OHP treatment, the patient started receiving capecitabine therapy. The patient is recurrence-free 3 years after surgery, 14 months after achieving a complete response (CR). We report a case of long-term CR after surgery for descending colon cancer with multiple liver metastases, followed by a "stop-and-go" method of administering L-OHP or CapeOX plus Bmab therapy. PMID:26805277

  3. Interaction between Capecitabine and Gemcitabine with Warfarin in a Patient with Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2008-11-01

    Full Text Available Gemcitabine is the only chemotherapeutic agent approved by the U.S. Food and Drug Administration (FDA for the treatment of patients with pancreatic cancer [1]. It is also indicated for use in non-small-cell lung cancer, bladder cancer, and is commonly used in other gastrointestinal malignancies. Patients with cancer, specifically pancreatic carcinoma, are at increased risk for thrombosis requiring anticoagulation. In addition, due to aging and common risk factors, cardiac ailments such as atrial fibrillation are also common in this group. In such cases, warfarin is generally the agent of choice In 1999, a potential interaction between gemcitabine and warfarin was reported [2]. In 2002, the manufacturer of gemcitabine, Eli Lilly, reported four similar cases, indicating an incidence of 0.04% suspected drug interaction between gemcitabine and an anticoagulant [3]. They also reported that overall 5.4% of patients undergoing gemcitabine therapy received concomitant anticoagulants [3] Moreover, the U.S. Food and Drug Administration and Roche have added a "Black Box" warning and strengthened the "Precautions" section on the label of capecitabine, which is indicated for the treatment of colorectal and breast cancer [4, 5]. We present the seventh case of a patient with pancreatic cancer complicated by an elevated INR following treatment with concomitant gemcitabine-capecitabinewarfarin first and then gemcitabine-warfarin later.

  4. XeNA: Capecitabine Plus Docetaxel, With or Without Trastuzumab, as Preoperative Therapy for Early Breast Cancer

    Directory of Open Access Journals (Sweden)

    Stefan Glück, Edward F. McKenna Jr, Melanie Royce

    2008-01-01

    Full Text Available Combinations of capecitabine and a taxane are highly active in metastatic breast cancer, and synergy between capecitabine and docetaxel has also been demonstrated. Such combinations potentially would provide a promising non–anthracycline-based alternative for patients with early breast cancer. Non-anthracycline preoperative regimens are a particularly interesting proposition in human epidermal growth factor receptor 2 (HER2-positive breast cancer, as they offer less cardiotoxicity and thus can be used concomitantly with preoperative trastuzumab therapy. Capecitabine plus docetaxel (XT and trastuzumab with XT (HXT are promising non-anthracycline regimens for the preoperative treatment of women with HER2-negative and HER2-positive breast cancer, respectively. The Xeloda in Neoadjuvant (XeNA trial, an open-label, multicenter, phase II study, independently assesses the efficacy of preoperative XT in HER2-negative and HXT in HER2-positive breast cancer. A particularly important feature of the XeNA study is the use of pathologic complete response (pCR plus near pCR (npCR as the primary endpoint. pCR is associated with long-term survival, and although it is valuable as a surrogate marker, pCR has some limitations. Measurement of residual breast cancer burden (RCB has been proposed as a more practical alternative to predict survival after preoperative chemotherapy. The combination of RCB-0 and RCB-I (npCR expands the subset of patients shown to benefit from preoperative chemotherapy, and achievement of pCR or npCR is associated with long disease-free survival. In XeNA, the sum of pCR and npCR will facilitate correlative studies designed to identify patients most likely to benefit from XT and HXT and may expedite the clinical evaluation of these novel preoperative regimens.

  5. Acute chest pain in a patient treated with capecitabine.

    NARCIS (Netherlands)

    Camaro, C.; Danse, P.W.; Bosker, H.A.

    2009-01-01

    A 61-year-old male with a history of metastatic colorectal cancer was referred to our hospital for primary coronary intervention because of acute ST-elevation myocardial infarction. Coronary angiography, however, revealed no significant stenoses. When asked, the patient revealed that capecitabine (X

  6. Preparation and Characterization of a Gastric Floating Dosage Form of Capecitabine

    Directory of Open Access Journals (Sweden)

    Ehsan Taghizadeh Davoudi

    2013-01-01

    Full Text Available Gastrointestinal disturbances, such as nausea and vomiting, are considered amongst the main adverse effects associated with oral anticancer drugs due to their fast release in the gastrointestinal tract (GIT. Sustained release formulations with proper release profiles can overcome some side effects of conventional formulations. The current study was designed to prepare sustained release tablets of Capecitabine, which is approved by the Food and Drug Administration (FDA for the treatment of advanced breast cancer, using hydroxypropyl methylcellulose (HPMC, carbomer934P, sodium alginate, and sodium bicarbonate. Tablets were prepared using the wet granulation method and characterized such that floating lag time, total floating time, hardness, friability, drug content, weight uniformity, and in vitro drug release were investigated. The sustained release tablets showed good hardness and passed the friability test. The tablets’ floating lag time was determined to be 30–200 seconds, and it floated more than 24 hours and released the drug for 24 hours. Then, the stability test was done and compared with the initial samples. In conclusion, by adjusting the right ratios of the excipients including release-retarding gel-forming polymers like HPMC K4M, Na alginate, carbomer934P, and sodium bicarbonate, sustained release Capecitabine floating tablet was formulated.

  7. Scleroderma in a Patient on Capecitabine: Is this a Variant of Hand-Foot Syndrome?

    Science.gov (United States)

    Agarwal, Archana; Hellinger, James; Park, Dorothy J; Volkmann, Elizabeth

    2016-01-01

    Drug-induced scleroderma is a rare adverse effect of some chemotherapeutic drugs, such as taxanes and bleomycin. Capecitabine, an oral fluoropyrimidine approved for the treatment of metastatic breast and colon cancer, commonly causes cutaneous side effects including the hand-and-foot syndrome (HFS). Scleroderma-like skin changes associated with HFS associated with capecitabine is rare. However, diffuse scleroderma has never before been reported. We report a case of capecitabine-induced diffuse/systemic scleroderma in an 86-year-old female treated with capecitabine for metastatic colorectal cancer. She developed progressive skin and visceral sclerosis involving the lungs. We discuss the association between chemotherapy and scleroderma. We believe this is the first case of diffuse/systemic capecitabine-induced scleroderma without the presence of HFS. Early diagnosis is essential as fibrosis might be prevented in early stages. The capecitabine should be discontinued as early as possible. PMID:27493845

  8. Concomitant boost radiotherapy in oropharynx carcinomas

    International Nuclear Information System (INIS)

    Fifty-five patients with resectable and unresectable oropharynx carcinomas were treated with concomitant boost radiotherapy. Forty-two of the patients (76%) had stages III-IV disease. Although none of the patients had undergone major surgery to the primary tumor, 11 had neck dissections prior to radiotherapy, and 19 (35%) received chemotherapy. The planned total tumor dose was 69.9 Gy, delivered over 5.5 weeks. During the last 3.5 weeks, a boost to the initial gross disease was delivered in 13 fractions of 1.5 Gy each, as a second daily fraction in a progressively accelerated schedule; the prescribed dose outside the boost volume thus was 50.4 Gy. Median follow-up for surviving patients was 31.5 months (range: 16-65 months). All patients but one completed the planned radiotherapy schedule. According to the RTOG scoring system, 48 patients (88%) presented with grades 3-4 acute toxicity. The rate of grades 3-4 late complications was 12%. At three years the actuarial locoregional control rate was 69.5% and overall survival was 60%. We conclude that this concomitant boost schedule is feasible and does not seem to be associated with an excess risk of late complications. Acute toxicity was higher in association with chemotherapy, but remained manageable. Although the oncological results appear encouraging, evaluation of the efficacy of concomitant boost schedules compared with conventionally fractionated irradiation with or without concomitant chemotherapy requires prospective randomized trials. (orig.)

  9. Concomitant boost radiotherapy in oropharynx carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Bieri, S.; Allal, A.S.; Kurtz, J.M. [Ospedale San Giovanni, Bellinzona (Switzerland). Dept. of Radiation Oncology; Dulguerov, P.; Lehmann, W. [Geneva Univ. Hospital (Switzerland). Div. of Head and Neck Surgery

    1998-12-31

    Fifty-five patients with resectable and unresectable oropharynx carcinomas were treated with concomitant boost radiotherapy. Forty-two of the patients (76%) had stages III-IV disease. Although none of the patients had undergone major surgery to the primary tumor, 11 had neck dissections prior to radiotherapy, and 19 (35%) received chemotherapy. The planned total tumor dose was 69.9 Gy, delivered over 5.5 weeks. During the last 3.5 weeks, a boost to the initial gross disease was delivered in 13 fractions of 1.5 Gy each, as a second daily fraction in a progressively accelerated schedule; the prescribed dose outside the boost volume thus was 50.4 Gy. Median follow-up for surviving patients was 31.5 months (range: 16-65 months). All patients but one completed the planned radiotherapy schedule. According to the RTOG scoring system, 48 patients (88%) presented with grades 3-4 acute toxicity. The rate of grades 3-4 late complications was 12%. At three years the actuarial locoregional control rate was 69.5% and overall survival was 60%. We conclude that this concomitant boost schedule is feasible and does not seem to be associated with an excess risk of late complications. Acute toxicity was higher in association with chemotherapy, but remained manageable. Although the oncological results appear encouraging, evaluation of the efficacy of concomitant boost schedules compared with conventionally fractionated irradiation with or without concomitant chemotherapy requires prospective randomized trials. (orig.)

  10. Acute chest pain in a patient treated with capecitabine.

    Science.gov (United States)

    Camaro, C; Danse, P W; Bosker, H A

    2009-08-01

    A 61-year-old male with a history of metastatic colorectal cancer was referred to our hospital for primary coronary intervention because of acute ST-elevation myocardial infarction. Coronary angiography, however, revealed no significant stenoses. When asked, the patient revealed that capecitabine (Xeloda(R)) was started by his oncologist one day before admission. It is known that this oral 5-FU analogue drug, used in metastatic colorectal cancer, can cause coronary artery spasms. The main treatment of capecitabine-induced vasospasm is discontinuation of the drug. Indeed, after cessation of the drug the patient remained free of symptoms and the ECG abnormalities normalised. (Neth Heart J 2009;17:288-91.). PMID:19789697

  11. Acute chest pain in a patient treated with capecitabine

    OpenAIRE

    Camaro, C.; Danse, P.W.; Bosker, H A

    2009-01-01

    A 61-year-old male with a history of metastatic colorectal cancer was referred to our hospital for primary coronary intervention because of acute ST-elevation myocardial infarction. Coronary angiography, however, revealed no significant stenoses. When asked, the patient revealed that capecitabine (Xeloda®) was started by his oncologist one day before admission. It is known that this oral 5-FU analogue drug, used in metastatic colorectal cancer, can cause coronary artery spasms. The main treat...

  12. Development of an oral dosage form of capecitabine with modified release characteristics

    NARCIS (Netherlands)

    Meulenaar, J

    2013-01-01

    Capecitabine is an orally-administered chemotherapeutic agent used in the treatment of a.o. metastatic breast, gastric and colorectal cancer and is commercially available as an immediate release tablet (Xeloda®, Roche). Capecitabine is a pre-pro-drug that is enzymatically converted into 5-fluorourac

  13. A prospective, non-randomized phase II trial of Trastuzumab and Capecitabine in patients with HER2 expressing metastasized pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Endlicher Esther

    2009-01-01

    Full Text Available Abstract Background Pancreatic cancer is the fourth most common cause of cancer related death in Western countries. Advantages in surgical techniques, radiation and chemotherapy had almost no impact on the long term survival of affected patients. Therefore, the need for better treatment strategies is urgent. HER2, a receptor tyrosine kinase of the EGFR family, involved in signal transduction pathways leading to cell growth and differentiation is overexpressed in a number of cancers, including breast and pancreatic cancer. While in breast cancer HER2 has already been successfully used as a treatment target, there are only limited data evaluating the effects of inhibiting HER2 tyrosine kinases in patients with pancreatic cancer. Methods Here we report the design of a prospective, non-randomized multi-centered Phase II clinical study evaluating the effects of the Fluoropyrimidine-carbamate Capecitabine (Xeloda ® and the monoclonal anti-HER2 antibody Trastuzumab (Herceptin® in patients with non-resectable, HER2 overexpressing pancreatic cancer. Patients eligible for the study will receive Trastuzumab infusions on day 1, 8 and 15 concomitant to the oral intake of Capecitabine from day 1 to day 14 of each three week cylce. Cycles will be repeated until tumor progression. A total of 37 patients will be enrolled with an interim analysis after 23 patients. Discussion Primary end point of the study is to determine the progression free survival after 12 weeks of bimodal treatment with the chemotherapeutic agent Capecitabine and the anti-HER2 antibody Trastuzumab. Secondary end points include patient's survival, toxicity analysis, quality of life, the correlation of HER2 overexpression and clinical response to Trastuzumab treatment and, finally, the correlation of CA19-9 plasma levels and progression free intervals.

  14. Detection of capecitabine (Xeloda®) on the skin surface after oral administration

    Science.gov (United States)

    Huang, Mao-Dong; Fuss, Harald; Lademann, Jürgen; Florek, Stefan; Patzelt, Alexa; Meinke, Martina C.; Jung, Sora

    2016-04-01

    Palmoplantar erythrodysesthesia (PPE), or hand-foot syndrome, is a cutaneous toxicity under various chemotherapeutics contributing to the most frequent side effects in patients treated with capecitabine (Xeloda®). The pathomechanism of PPE has been unclear. Here, the topical detection of capecitabine in the skin after oral application was shown in 10 patients receiving 2500 mg/m2/day capecitabine. Sweat samples were taken prior to and one week after oral administration of capecitabine. Using high-resolution continuum source absorption spectrometry, the changes in concentrations of fluorine, which is an ingredient of capecitabine, were quantified and statistically analyzed. Here, we show an increase in fluorine concentrations from 40±10 ppb (2±0.5 pM) before capecitabine administration to 27.7±11.8 ppm (14.6±6.5 nM) after application, p<0.001. The results show the secretion of capecitabine on the skin surface after oral administration, indicating a local toxic effect as a possible pathomechanism of PPE.

  15. Low-dose capecitabine (Xeloda) for treatment for gastrointestinal cancer

    OpenAIRE

    Miger, Jasmine; Holmqvist, Annica; Sun, Xiao-Feng; Albertsson, Maria

    2014-01-01

    The prodrug capecitabine (Xeloda) has been an important drug for treatment for gastrointestinal cancer (GI-cancer). This study explores the efficacy of continuous metronomic Xeloda, as well as tolerability and best response during treatment. Patients (n = 35) with stage IV GI-cancer were included in the study and were divided into two groups; upper (n = 13) and lower (n = 22) GI-cancer. All patients were given continuous metronomic Xeloda (500 mg × 2). Best response was measured by radiologic...

  16. Predictive Factors of Lapatinib and Capecitabine Activity in Patients with HER2-Positive, Trastuzumab-Resistant Metastatic Breast Cancer: Results from the Italian Retrospective Multicenter HERLAPAC Study.

    Directory of Open Access Journals (Sweden)

    Stefania Gori

    Full Text Available There are no validated predictive markers for lapatinib and capecitabine in patients with trastuzumab-resistant HER2 positive metastatic breast cancer.Data of 148 consecutive patients treated with lapatinib and capecitabine from March 2007 to December 2013 were collected from 13 Italian institutions. Estimates of progression-free survival (PFS and overall survival (OS were obtained with the Kaplan-Meier method and compared with logrank test. The association of clinicopathological variables and the outcome was studied by binary logistic regression analysis and Cox proportional hazard analysis.At a median follow-up of 41 months, median PFS and OS were 7 and 21 months, respectively. Patents with a PFS longer than 7 months had a significantly longer OS, compared with patients with a PFS equal to or shorter than 7 months (36 vs 15 months; p<0.001. Multivariate analysis revealed the benefit of lapatinib-based therapy in terms of PFS and OS was significantly associated with time-to-progression (TTP on prior first-line trastuzumab-based therapy. In particular, each additional month on first-line trastuzumab based therapy was associated with a reduction in hazard of progression and death after the initiation of lapatinib-based therapy of 2% and 4%, respectively.A longer TTP to first line trastuzumab seems to predict a prolonged PFS and OS with subsequent lapatinib and capecitabine.

  17. Phase I Trial of Preoperative Hypofractionated Intensity-Modulated Radiotherapy with Incorporated Boost and Oral Capecitabine in Locally Advanced Rectal Cancer

    International Nuclear Information System (INIS)

    Purpose: To determine the safety and efficacy of preoperative hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) and an incorporated boost with concurrent capecitabine in patients with locally advanced rectal cancer. Methods and Materials: The eligibility criteria included adenocarcinoma of the rectum, T3-T4 and/or N1-N2 disease, performance status 0 or 1, and age ≥18 years. Photon IMRT and an incorporated boost were used to treat the whole pelvis to 45 Gy and the gross tumor volume plus 2 cm to 55 Gy in 25 treatments within 5 weeks. The study was designed to escalate the dose to the gross tumor volume in 5-Gy increments in 3-patient cohorts. Capecitabine was given orally 825 mg/m2 twice daily for 7 days each week during RT. The primary endpoint was the maximal tolerated radiation dose, and the secondary endpoints were the pathologic response and quality of life. Results: Eight patients completed RT at the initial dose level of 55 Gy. The study was discontinued because of toxicity-six Grade 3 toxicities occurred in 3 (38%) of 8 patients. All patients went on to definitive surgical resection, and no patient had a pathologically complete response. Conclusion: This regimen, using hypofractionated RT with an incorporated boost, had unacceptable toxicity despite using standard doses of capecitabine and IMRT. Additional research is needed to determine whether IMRT is able to reduce the side effects during and after pelvic RT with conventional dose fractionation

  18. Concomitant boost radiotherapy in oropharynx carcinomas

    OpenAIRE

    Bieri, Sabine; Allal, Abdelkarim Said; Dulguerov, Pavel; Lehmann, Willy; Kurtz, John

    1998-01-01

    Fifty-five patients with resectable and unresectable oropharynx carcinomas were treated with concomitant boost radiotherapy. Forty-two of the patients (76%) had stages III-IV disease. Although none of the patients had undergone major surgery to the primary tumor, 11 had neck dissections prior to radiotherapy, and 19 (35%) received chemotherapy. The planned total tumor dose was 69.9 Gy, delivered over 5.5 weeks. During the last 3.5 weeks, a boost to the initial gross disease was delivered in 1...

  19. Development of an oral dosage form of capecitabine with modified release characteristics

    OpenAIRE

    Meulenaar, J

    2013-01-01

    Capecitabine is an orally-administered chemotherapeutic agent used in the treatment of a.o. metastatic breast, gastric and colorectal cancer and is commercially available as an immediate release tablet (Xeloda®, Roche). Capecitabine is a pre-pro-drug that is enzymatically converted into 5-fluorouracil (5-FU) in the liver and the tumor. In tumor it inhibits DNA synthesis and slows tumor growth. To form 5-FU, the activation of capecitabine follows a three-step enzymatic pathway with two interme...

  20. A phase II trial of neoadjuvant IMRT-based chemoradiotherapy followed by one cycle of capecitabine for stage II/III rectal adenocarcinoma

    International Nuclear Information System (INIS)

    Neoadjuvant chemoradiation has become the standard treatment in locally advanced rectal cancer (LARC) and improves local control. This study explored the feasibility of an intensified chemoradiation treatment followed by one cycle of capecitabine before surgery for LARC. Patients with histologically confirmed, newly diagnosed, locally advanced rectal adenocarcinoma (cT3-T4 and/or cN+) located within 12 cm of the anal verge were included in this study. Patients received intensity-modulated radiation therapy (IMRT) to the pelvis (total dose 44 Gy in 20 fractions), as well as concurrent oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 b.i.d. d1–5 weekly). One cycle of capecitabine (1000 mg/m2 b.i.d. d1–14) was given two weeks after the completion of concomitant chemoradiation, and radical surgery was scheduled six weeks after chemoradiation. Between October 2007 and November 2008, a total of 42 patients were enrolled in the study (median age 51 years; 31 male). Of these, 38 underwent surgical resection and 4 refused radical surgery because of almost complete primary tumor regression and complete symptom relief after neoadjuvant therapy. Fifteen patients underwent sphincter-sparing lower anterior resection. Six patients had a pathological complete response (pCR). The incidence of grade 3 hematologic, gastro-intestinal, and skin toxicities were 4.7%, 14.3%, and 26.2%, respectively. Grade 4 toxicity was not observed. Surgical complications (incisional infection within 2–3 weeks after surgery) were observed in 5 patients. Good responders (defined as TRG 3–4) had a significant difference in DFS (81.6% vs. 16.8%, respectively; p = 0.000) and OS (83.9% vs. 40.7%, respectively; p = 0.007) compared to those who were evaluated as TRG 1–2. Our study indicates that neoadjuvant chemoradiation followed by one cycle of capecitabine before surgery has a good treatment efficacy, with only mild toxicities associated with chemoradiation and acceptable surgical

  1. Acute myocardial infarction after capecitabine treatment: not always vasospasm is responsible

    Institute of Scientific and Technical Information of China (English)

    Tolga Sinan G(ü)venc; Emel Celiker; Kazlm Serhan (O)zcan; Erkan (I)lhan; Mehmet Eren

    2012-01-01

    Capecitabine is an orally available chemotherapeutic agent that is converted to 5-fluorouracil (5-FU) after absorbtion.Capecitabine and its active metabolite,5-FU,have cardiotoxic effects with reported instances of acute coronary syndromes caused due to coronary vasospasm.However,these agents exert toxic effects on cardiovascular system and beyond vasospasm provacation.We report a 46-year-old patient diagnosed as acute inferior infarction who is treated with capecitabine for 3 months due to metastatic breast carcinoma,in whom thrombotic coronary occlusion was observed in angiography.This case demonstrates that apart from vasospasm,coronary thrombosis could be observed after capecitabine treatment,with a possible direct effect of this drug.

  2. Capecitabine Induced Multifocal Leukoencephalopathy: Do We Have Always to Switch off the Chemotherapy?

    Directory of Open Access Journals (Sweden)

    Anastasia Bougea

    2016-01-01

    Full Text Available Capecitabine is a well tolerated and safe 5-fluorouracil agent for adjuvant, neoadjuvant chemotherapy or metastatic cases. Neurological side effects require discontinuation of chemotherapy. We report this unique case of a 50-year-old female, who presented an isolated episode of dysarthria and ataxia under bevacizumab, capecitabine, and oxaliplatin treatment due to reversible multifocal leukoencephalopathy that did not recur after readministration of chemotherapy.

  3. Chronomodulierte Gabe versus Standardapplikation von Capecitabin bei metastasiertem kolorektalen Karzinom - Versuch einer Therapieoptimierung

    OpenAIRE

    Rauch, Stefanie

    2009-01-01

    Capecitabin (Xeloda®) ist ein Prodrug von 5-Fluorouracil und findet als orale Chemotherapie in der palliativen first-line Therapie des metastasierten kolorektalen Karzinoms Verwendung. In der vorliegenden Arbeit wurde die chonomodulierte Medikamentengabe von Capecitabin mit der herkömmlichen Standard-Gabe verglichen, mit dem Hintergrund, die therapiebedingten Nebenwirkungen � insbesondere das Hand-Fuß-Syndrom - durch die chronomodulierte Verabreichung von Xeloda® zu minimieren. Sekundär s...

  4. Efficacy of the Oral Fluorouracil Pro-drug Capecitabine in Cancer Treatment: a Review

    OpenAIRE

    John Kouvaris; Haralabos Zabatis; Georgios A. Zacharias; Michael J. Koukourakis; Vassilios Kouloulias; Koukourakis, Georgios V

    2008-01-01

    Abstract: Capecitabine (Xeloda®) was developed as a pro-drug of fluorouracil (FU), with the aim of improving tolerability and intratumor drug concentrations through its tumorspecific conversion to the active drug. The purpose of this paper is to review the available information on capecitabine, focusing on its clinical effectiveness against various carcinomas. Identification of all eligible English trails was made by searching the PubMed and Cochrane databases from 1980 to 2007. Search ter...

  5. Capecitabine Induced Multifocal Leukoencephalopathy: Do We Have Always to Switch off the Chemotherapy?

    Science.gov (United States)

    Bougea, Anastasia; Voskou, Panagiota; Kilidireas, Constantinos; Andreadou, Elisabeth

    2016-01-01

    Capecitabine is a well tolerated and safe 5-fluorouracil agent for adjuvant, neoadjuvant chemotherapy or metastatic cases. Neurological side effects require discontinuation of chemotherapy. We report this unique case of a 50-year-old female, who presented an isolated episode of dysarthria and ataxia under bevacizumab, capecitabine, and oxaliplatin treatment due to reversible multifocal leukoencephalopathy that did not recur after readministration of chemotherapy. PMID:26966603

  6. A dose-escalation study of indisulam in combination with capecitabine (Xeloda) in patients with solid tumours

    OpenAIRE

    Siegel-Lakhai, W S; Zandvliet, A S; Huitema, A D R; Tibben, M. M.; Milano, G.; Girre, V.; Diéras, V; King, A; Richmond, E; Wanders, J.; Beijnen, J H; Schellens, J H M

    2008-01-01

    This dose escalation study was designed to determine the recommended dose of the multi-targeted cell cycle inhibitor indisulam in combination with capecitabine in patients with solid tumours and to evaluate the pharmacokinetics of the combination. Thirty-five patients were treated with indisulam on day 1 of each 21-day cycle. Capecitabine was administered two times daily (BID) on days 1–14. Plasma concentrations of indisulam, capecitabine and its three metabolites were determined for pharmaco...

  7. Efficacy of the Oral Fluorouracil Pro-drug Capecitabine in Cancer Treatment: a Review

    Directory of Open Access Journals (Sweden)

    John Kouvaris

    2008-08-01

    Full Text Available Abstract: Capecitabine (Xeloda® was developed as a pro-drug of fluorouracil (FU, with the aim of improving tolerability and intratumor drug concentrations through its tumorspecific conversion to the active drug. The purpose of this paper is to review the available information on capecitabine, focusing on its clinical effectiveness against various carcinomas. Identification of all eligible English trails was made by searching the PubMed and Cochrane databases from 1980 to 2007. Search terms included capecitabine, Xeloda and cancer treatment. Nowadays, FDA has approved the use of capecitabine as a first line therapy in patients with metastatic colorectal cancer when single-agent fluoropyrimidine is preferred. The drug is also approved for use as a single agent in metastatic breast cancer patients who are resistant to both anthracycline and paclitaxel-based regimens or when further anthracycline treatment is contraindicated. It is also approved in combination with docetaxel after failure of prior anthracycline-based chemotherapy. In patients with prostate, pancreatic, renal cell and ovarian carcinomas, capecitabine as a single-agent or in combination with other drugs has also shown benefits. Improved tolerability and comparable efficacy, compared with the intravenous FU/LV combination, in addition to its oral administration, make capecitabine an attractive option for the treatment of several types of carcinomas.

  8. Role of capecitabine in treating metastatic colorectal cancer in Chinese patients

    Directory of Open Access Journals (Sweden)

    Wang F

    2014-04-01

    Full Text Available Feng Wang,* Feng-Hua Wang,* Long Bai, Rui-Hua XuDepartment of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China *These authors contributed equally to this workAbstract: The China Food and Drug Administration approved the use of capecitabine in patients with metastatic colorectal cancer (mCRC in 2004. This paper reviews the available information of capecitabine in Chinese patients with mCRC, focusing on its effectiveness and safety against mCRC. Identification of all eligible studies was made by searching the PubMed and Wanfang database from 2000 to 2013. Published data examining various aspects of clinical response and tolerability with capecitabine alone or in combination with other chemotherapeutic or biological agents for first- and second-line mCRC were examined. Capecitabine and its combination displayed high efficacy in Chinese patients with mCRC. Toxicities are generally manageable, and elderly patients can tolerate capecitabine well.Keywords: capecitabine, metastatic colorectal cancer, Chinese

  9. Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Yuan-Hong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Lin, Jun-Zhong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); An, Xin [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Luo, Jie-Lin [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); Cai, Mu-Yan [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou (China); Cai, Pei-Qiang [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou (China); Kong, Ling-Heng; Liu, Guo-Chen; Tang, Jing-Hua; Chen, Gong; Pan, Zhi-Zhong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); Ding, Pei-Rong, E-mail: dingpr@mail.sysu.edu.cn [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China)

    2014-12-01

    Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications. Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded. Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgery because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively. Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen

  10. Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial

    International Nuclear Information System (INIS)

    Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications. Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded. Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgery because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively. Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen

  11. Clinical Efficacy of Capecitabine and Cyclophosphamide (XC in Patients with Metastatic Breast Cancer

    Directory of Open Access Journals (Sweden)

    Shien,Tadahiko

    2011-08-01

    Full Text Available Combined low-dose therapy of oral capecitabine (Xeloda and cyclophosphamide (XC has been demonstrated to be useful for long-term control of lesions in patients with metastatic breast cancer (MBC and is aimed at symptomatic alleviation and prolongation of survival. Here, a retrospective review was conducted of MBC patients administered XC at the Okayama University Hospital (OUH, to evaluate responses to XC, adverse events and time to progression (TTP. Twenty patients with MBC received XC between 2006 and 2009. With the exception of 2 elderly patients who were over the age of 70 at the initial examination, all of the patients had received prior treatment with an anthracycline and/or a taxane. No complete response (CR cases were observed, but partial response (PR was achieved in 6 patients (30% and SD in 9 (45%, of whom 5 (20% sustained SD status for >12 months. The median TTP was 6 months (range:3-27 mo.. Three patients developed Grade 3 adverse events (diarrhea, nausea and stomatitis, but no other patients developed adverse reactions causing interruption of the therapy. XC was safe even in previously treated and elderly MBC patients;moreover, it yielded remarkable clinical responses.

  12. Preclinical studies of concomitant chemoradiation

    International Nuclear Information System (INIS)

    Animal models are widely used in preclinical studies in order to explain the mechanisms of action of chemotherapy, radiotherapy and concomitant chemoradiation, to analyze pathophysiology of tumors and to evaluate the treatment of choice for malignant tumors. The choice of murine tumor or human tumor xenograft system is still debated. Xenografted human tumors have two main advantages: their human origin and wanted pathological type, which is necessary for future clinical studies. There are a lot of disadvantages of xenografted tumors: the stroma and vascular network of transplanted tumors have murine origin, the graft is mostly ectopic, the volume of transplanted tumors at the time of chemoradiotherapy is much smaller than that of the tumor in man; due to residual immunity it is difficult to determine response to cytotoxic treatment. It is still impossible to extrapolate the results obtained in a tumor model in animal to man. These investigations are useful for interpretation of clinical results and for proposing the less empirical method of chemoradiation for phase II clinical trials. (author)

  13. DPD is a molecular determinant of capecitabine efficacy in colorectal cancer

    DEFF Research Database (Denmark)

    Vallböhmer, Daniel; Yang, Dong Yun; Kuramochi, Hidekazu;

    2007-01-01

    Capecitabine is a fluoropyrimidine-based drug that offers physicians a more convenient treatment for advanced colorectal cancer (CRC), with manageable toxicity and antitumor activity comparable to that of continuous-infusion therapies with 5-fluorouracil (5-FU). However, there are no validated and...... study and treated with single agent capecitabine. The intratumoral mRNA levels of DPD, TP and TS were assessed from paraffin-embedded tissue samples using laser-capture-microdissection methods and quantitative real-time PCR. There were 20 women and 17 men with a median age of 61 years (range 49-74). The...... fluoropyrimidine-based drugs in various tumors. Therefore, we investigated whether intratumoral mRNA expression levels of these genes are also associated with the clinical outcome of patients with metastatic CRC treated with first-line capecitabine. Thirty-seven patients with metastatic CRC were enrolled in this...

  14. CAPECITABINE IN THE TREATMENT OF BRAIN METASTATIC LESION IN PATIENTS WITH BREAST CANCER

    Directory of Open Access Journals (Sweden)

    E. A. Moskvina

    2012-01-01

    Full Text Available The paper considers the experience with capecitabine in 67 patients with brain metastatic lesion from breast cancer. The immediate efficacy of capecitabine and the results of therapy with the agent were analyzed in the groups of its use alone and in combination with radiotherapy both for therapeutic purposes and as an adjuvant regimen. In the chemoradiation therapy group, the objective effects in the brain were 73 %. The median time to progression was 12.27 months. In the monochemotherapy group, the objective effects were 30 %. The median time to progression was 4 months. The results of the investigation show that capecitabine has pronounced antitumor activity and moderate toxicity. Combination treatment is the method of choice. 

  15. Comparison of capecitabine and 5-fluorouracil in chemoradiotherapy for locally advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Although capecitabine has theoretical advantages in the pharmacokinetics, such as higher intratumoral and lower systemic concentration, relative to bolus 5-fluorouracil (5-FU), outcomes of chemoradiotherapy (CRT) with capecitabine or bolus 5-FU have not been directly compared in patients with locally advanced pancreatic cancer. Therefore, we retrospectively compared the outcomes, including toxicity, tumor response, and overall survival, of oral capecitabine plus radiotherapy (RT) with bolus 5-FU plus RT, in patients with locally advanced pancreatic cancer. Between August 2006 and January 2012, 98 patients with locally advanced pancreatic cancer received CRT, with 52 receiving concurrent oral capecitabine and 46 receiving bolus injection of 5-FU. Primary tumor and overall response after CRT were evaluated radiologically, and toxicity, tumor response, and overall survival (OS) were compared in the two groups. Baseline clinical parameters of the two groups were similar. The rates of ≥ Grade 3 hematologic (0% vs. 8.7%, p = 0.045) and non-hematologic (0% vs. 8.7%, p = 0.045) toxicities were significantly lower in the capecitabine group than in the 5-FU group. Primary tumor (30.7% vs. 28.2%, p = 0.658) and overall (13.7% vs. 15.2%, p = 0.273) response rates and median OS time (12.5 months vs. 11.6 months, p = 0.655) were similar in the two groups. Capecitabine plus RT may be a safe and feasible regimen for patients with locally advanced pancreatic cancer, with similar efficacy and low rates of toxicities compared with bolus 5-FU plus RT

  16. Treatment with capecitabine + bevacizumab following induction treatment with FOLFIRI + bevacizumab in metastatic colorectal carcinoma

    Science.gov (United States)

    Tatlı, Ali Murat; Coşkun, Hasan Şenol; Uysal, Mükremin; Arslan, Deniz; Sezgin Göksu, Sema; Güenay Gündüz, Şeyda; Çakal, Selda; Bozcuk, Hakan Şat; Savaş, Burhan

    2014-01-01

    Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor, and it has been found to increase both progression-free survival and overall survival when it is combined with chemotherapeutic agents in the first-line and subsequent treatment of metastatic colorectal carcinoma. The objective of this study was to show the efficacy of maintenance treatment with capecitabine plus bevacizumab in patients with metastatic colorectal cancer who responded to treatment with FOLFIRI plus bevacizumab. The study included patients with metastatic colorectal cancer who received FOLFIRI plus bevacizumab as a first-line treatment. Patients who had objective response with FOLFIRI plus bevacizumab treatment after an average period of 6 months received a maintenance treatment with capecitabine plus bevacizumab (capecitabine 2 x 1000 mg/m2, 1 - 14 days, every 21 days, bevacizumab 7.5 mg/m2, every 21 days) until disease progression or toxicity. The time to progression on bevacizumab treatment was evaluated. A total of 29 patients (15 male, 14 female) were included. The mean age was 62 years. The mean number of cycles for maintenance treatment with capecitabine plus bevacizumab was 12. The median PFS was 16 ± 3 months, and OS was 42 ± 11 months. PFS and OS were remarkably higher in patients with a complete or near complete response to induction treatment. Fourteen patients (48%) experienced hand-foot syndrome associated with capecitabine plus bevacizumab treatment, without any severe toxicity. Inselected patients with metastatic colorectal carcinoma who had a remarkable objective response to FOLFIRI plus bevacizumab treatment, a maintenance treatment with capecitabine plus bevacizumab following FOLFIRI plus bevacizumab until disease progression may be a suitable, effective and tolerable regimen, which requires further studies. PMID:25232406

  17. The use of capecitabine in daily practice: a study on adherence and patients' experiences

    Directory of Open Access Journals (Sweden)

    Timmers L

    2012-10-01

    Full Text Available Lonneke Timmers,1 Eleonora L Swart,1 Christel CLM Boons,1 Dirk Mangnus,1 Peter M van de Ven,2 Godefridus J Peters,3 Epie Boven,3 Jacqueline G Hugtenburg11Department of Clinical Pharmacology and Pharmacy, 2Department of Epidemiology and Biostatistics, 3Department of Medical Oncology, VU University Medical Center, Amsterdam, The NetherlandsBackground: Adherence to pharmacological therapy is a complex and multifactorial issue that can substantially alter the outcome of treatment. Especially when using long-term medication, cancer patients have adherence rates similar to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for nonadherence is essential for the development of interventions that may improve adherence. This report presents the CAPER-capecitabine protocol, which is designed to study the adherence to capecitabine and the influence of patient attitudes towards medication and self-reported side effects. Furthermore, the relationships between patient characteristics, disease characteristics, side effects, quality of life, patient beliefs and attitudes towards disease and medication, dose adjustments, reasons for discontinuation, and plasma concentration of three of the main metabolites, including the active compound 5-fluorouracil, will be explored.Methods: In this multicenter, prospective, observational cohort study, 90 patients aged 18 years or older starting treatment with capecitabine will be included and followed for a period up to five cycles. The main study parameters are adherence, patient attitudes towards medication, and the number and grade of patient-reported side effects. At baseline and during week 2 of cycles 1, 3 and 5, patients will be asked to donate blood and fill out a questionnaire. Blood samples will be analyzed for plasma

  18. Long-Term Survival on Capecitabine in Two Gemcitabine Refractory Pancreatic Cancer Patients. Is there a Pharmacogenetic Explanation?

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2007-11-01

    Full Text Available Context Capecitabine has shown efficacy in treatment of metastatic pancreatic cancer. Several researchers have identified thymidine phosphorylase, dihydropyrimidine dehydrogenase, or their ratio as indicators of response to capecitabine in various cancers. Case report We report two patients with metastatic pancreatic carcinoma who had long-term survivals on capecitabine after gemcitabine failure. These two cases prompted us to measure thymidine phosphorylase and dihydropyrimidine dehydrogenase levels to facilitate discourses regarding their relationship with efficacy of capecitabine. We also describe a novel method of measuring thymidine phosphorylase level from serum without an invasive tissue biopsy. One patient is alive as of today, with improved performance status, 50 months after capecitabine was started. CA 19-9 and CT scans remained stable during 57 cycles. Her thymidine phosphorylase level was 1.77 compared to a control level of 1.00. Dihydropyrimidine dehydrogenase level was 4.14 compared to a control level of 1.00. Their ratio was 0.43. The other patient was alive on capecitabine for 24 months. His performance status, bilirubin, AST, and ALT improved on capecitabine. CT scans and CA 19-9 remained stable during this period. He had thymidine phosphorylase level of 5.56, dihydropyrimidine dehydrogenase level of 2.74, and their ratio of 2.03. Conclusion Capecitabine resulted in long term survivals in two patients with metastatic pancreatic cancer after gemcitabine failure. The use of capecitabine as second-line treatment in metastatic pancreatic cancer should be further explored along with the role of thymidine phosphorylase and dihydropyrimidine dehydrogenase levels in its activity. A non-invasive method of thymidine phosphorylase measurement we described should be validated in larger trials.

  19. Neoadjuvant capecitabine, radiotherapy, and bevacizumab (CRAB) in locally advanced rectal cancer: results of an open-label phase II study

    OpenAIRE

    Edhemovic Ibrahim; Oblak Irena; Anderluh Franc; Bracko Matej; Music Maja; Ocvirk Janja; Velenik Vaneja; Brecelj Erik; Kropivnik Mateja; Omejc Mirko

    2011-01-01

    Abstract Background Preoperative capecitabine-based chemoradiation is a standard treatment for locally advanced rectal cancer (LARC). Here, we explored the safety and efficacy of the addition of bevacizumab to capecitabine and concurrent radiotherapy for LARC. Methods Patients with MRI-confirmed stage II/III rectal cancer received bevacizumab 5 mg/kg i.v. 2 weeks prior to neoadjuvant chemoradiotherapy followed by bevacizumab 5 mg/kg on Days 1, 15 and 29, capecitabine 825 mg/m2 twice daily on ...

  20. Gemcitabine and capecitabine for heavily pre-treated metastatic colorectal cancer patients

    DEFF Research Database (Denmark)

    Spindler, Karen-Lise G; Pallisgaard, Niels; Andersen, Rikke F;

    2014-01-01

    AIM: We investigated the efficacy and safety of capecitabine and gemcitabin (GemCap) in heavily pre-treated, therapy-resistant metastatic colorectal cancer (mCRC) patients and the clinical importance of cell-free DNA (cfDNA) measurement. PATIENTS AND METHODS: Patients' inclusion criteria included...

  1. Clinical observation of capecitabine monotherapy in elderly patients with advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    Miao Zhang; Zhaozhe Liu Co-first author; Zhendong Zheng; Tao Han; Yaling Han; Min Song; Xiaodong Xie

    2015-01-01

    Objective The aim of the study was to evaluate the safety and ef icacy of capecitabine mono-chemo-therapy in elderly patients with advanced breast cancer. Methods The data from 36 cases of capecitabine monotherapy in elderly patients with advanced breast cancer were retrospectively analyzed. Oral administration of capecitabine 2000 mg/m2 twice daily (D1–14) for 21 days constituted a cycle. The ef ect of the disease and main adverse reactions were evaluated every 2 cycles. Results The data from 36 elderly patients were studied. The median number of chemotherapy cycles was 4. The total ef ective rate was 30.6% (11/36) and the disease control rate was 72.2% (26/36). The number of patients with clinical complete remission was 2, clinical partial response was 9, stable disease was 15, and progressive disease was 10. Where treatment was ef ective, the median time to progression was 6 months and the median overal survival was 9.5 months. The main adverse events were gastroin-testinal reactions, bone marrow suppression, and oral mucositis; most of the reactions were grade 1 to 2. Grade 3 to 4 adverse reactions included granulocytopenia in 2 patients (12.5%) and hand-foot syndrome in 1 patient (6.7%). Conclusion Capecitabine monotherapy was ef ective in control ing disease progression, and adverse reactions were tolerated by elderly patients with advanced breast cancer.

  2. STUDY ON ADHERENCE TO CAPECITABINE AMONG PATIENTS WITH COLORECTAL CANCER AND METASTATIC BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Adiel Goes de FIGUEIREDO JUNIOR

    2014-09-01

    Full Text Available Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance.

  3. Capecitabine with radiation is an effective adjuvant therapy in gastric cancers

    OpenAIRE

    Tham, Chee Kian; Choo, Su Pin; Poon, Donald Yew Hee; Toh, Han Chong; Ong, Simon Yew Kuang; Tan, Sze Huey; Wang, Michael Lian Chek; Foo, Kian Fong

    2010-01-01

    AIM: To analyze the outcome of patients who received concurrent capecitabine (Xeloda) and radiation (XRT) compared to the established concurrent 5-fluorouracil (5-FU) with radiation (5FU-RT) and fluoropyrimidine-based chemotherapy alone as adjuvant treatment in gastric cancers.

  4. Non-covalent interactions involving halogenated derivatives of capecitabine and thymidylate synthase: a computational approach.

    Science.gov (United States)

    Rahman, Adhip; Hoque, Mohammad Mazharol; Khan, Mohammad A K; Sarwar, Mohammed G; Halim, Mohammad A

    2016-01-01

    Capecitabine, a fluoropyrimidine prodrug, has been a frequently chosen ligand for the last one and half decades to inhibit thymidylate synthase (TYMS) for treatment of colorectal cancer. TYMS is a key enzyme for de novo synthesis of deoxythymidine monophosphate and subsequent synthesis of DNA. Recent years have also seen the trait of modifying ligands using halogens and trifluoromethyl (-CF3) group to ensure enhanced drug performance. In this study, in silico modification of capecitabine with Cl, Br, I atoms and -CF3 group has been performed. Density functional theory has been employed to optimize the drug molecules and elucidate their thermodynamic and electrical properties such as Gibbs free energy, enthalpy, electronic energy, dipole moment and frontier orbital features (HOMO-LUMO gap, hardness and softness). Flexible and rigid molecular docking have been implemented between drugs and the receptor TYMS. Both inter- and intra-molecular non-covalent interactions involving the amino acid residues of TYMS and the drug molecules are explored in details. The drugs were superimposed on the resolved crystal structure (at 1.9 Å) of ZD1694/dUMP/TYMS system to shed light on similarity of the binding of capecitabine, and its modifiers, to that of ZD1694. Together, these results may provide more insights prior to synthesizing halogen-directed derivatives of capecitabine for anticancer treatment. PMID:27026843

  5. Metronomic capecitabine in gastroenteropancreatic neuroendrocrine tumors: a suitable regimen and review of the literature

    Directory of Open Access Journals (Sweden)

    Bongiovanni A

    2014-10-01

    Full Text Available Alberto Bongiovanni,1 Nada Riva,1 Sebastiano Calpona,1 Marianna Ricci,1 Erica Gunelli,1 Chiara Liverani,1 Federico La Manna,1 Alessandro De Vita,1 Manuela Monti,1 Stefano Severi,2 Federica Pieri,3 Elena Amadori,1 Riccardo Galassi,1 Davide Cavaliere,4 Alberto Zaccaroni,5 Andreas Tartaglia,6 Veronica Lunedei,7 Andrea Gardini,8 Laura Mercatali,1 Dino Amadori,1 Toni Ibrahim11Osteoncology and Rare Tumors Center, 2Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS, Meldola, 3Pathology Unit, 4Unit of Oncological Surgery and Advanced Therapies, 5Endocrine Surgery Unit, 6Endocrinology Unit, 7Gastroenterology and Digestive Endoscopy Unit, 8Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, ItalyBackground: We present a retrospective analysis of metronomic capecitabine in metastatic gastroenteropancreatic neuroendrocrine tumors (GEP-NETs. A review of the literature is also presented.Methods: From January 2007 to December 2013, ten patients with metastatic GEP-NETs (four pancreatic and six ileal who progressed after treatment with somatostatin analogs and other cytotoxic agents received oral capecitabine 1,500 mg/day continuously. The median patient age was 68 (range 29–82 years. The median treatment duration was 8 months.Results: Five (50% patients achieved a partial radiographic response, four (40% showed stable disease, and one (10% progressed. Median overall survival was 56 months. Three of the four pancreatic patients achieved a partial radiographic response that lasted for a median of 15.5 months; overall survival and progression-free survival in this subgroup was 58 and 6 months, respectively.Conclusion: Data in the literature show that capecitabine has only occasionally been used as a single agent, with increased toxicity. Only one study using single-agent capecitabine reported a progression-free survival of 9.9 months and overall survival of 36.5 months, without an objective

  6. Intrahepatic and systemic therapy with oxaliplatin combined with capecitabine in patients with hepatic metastases from breast cancer

    DEFF Research Database (Denmark)

    Nielsen, D L; Nørgaard, H; Weber Vestermark, Lene;

    2012-01-01

    The aim was to evaluate activity and toxicity of hepatic arterial infusion of oxaliplatin in combination with capecitabine in patients with metastatic breast cancer with liver metastases and limited extrahepatic disease....

  7. Nearly Complete Response of Brain Metastases from HER2 Overexpressing Breast Cancer with Lapatinib and Capecitabine after Whole Brain Irradiation

    Directory of Open Access Journals (Sweden)

    Esin Oktay

    2013-01-01

    Full Text Available Trastuzumab treatment does not prevent intracranial seeding and is largely ineffective for established central nervous system metastasis in HER2 overexpressing breast cancer patients. Combination therapy of lapatinib and capecitabine may be an effective treatment option for brain metastasis of HER2-positive breast cancer. We report a patient with breast cancer overexpressing HER-2 where brain metastases were successfully treated with radiation and a combination of lapatinib and capecitabine.

  8. Q-TWiST analysis of lapatinib combined with capecitabine for the treatment of metastatic breast cancer

    OpenAIRE

    Sherrill, B.; Amonkar, M.M.; S. Stein; Walker, M.; Geyer, C; Cameron, D.

    2008-01-01

    The addition of lapatinib (Tykerb/Tyverb) to capecitabine (Xeloda) delays disease progression more effectively than capecitabine monotherapy in women with previously treated HER2+ metastatic breast cancer (MBC). The quality-adjusted time without symptoms of disease or toxicity of treatment (Q-TWiST) method was used to compare treatments. The area under survival curves was partitioned into health states: toxicity (TOX), time without symptoms of disease progression or toxicity (TWiST), and rela...

  9. XeNA: Capecitabine Plus Docetaxel, With or Without Trastuzumab, as Preoperative Therapy for Early Breast Cancer

    OpenAIRE

    Stefan Glück, Edward F. McKenna Jr, Melanie Royce

    2008-01-01

    Combinations of capecitabine and a taxane are highly active in metastatic breast cancer, and synergy between capecitabine and docetaxel has also been demonstrated. Such combinations potentially would provide a promising non–anthracycline-based alternative for patients with early breast cancer. Non-anthracycline preoperative regimens are a particularly interesting proposition in human epidermal growth factor receptor 2 (HER2)-positive breast cancer, as they offer less cardiotoxicity and ...

  10. XeNA: Capecitabine Plus Docetaxel, With or Without Trastuzumab, as Preoperative Therapy for Early Breast Cancer

    OpenAIRE

    Glück, Stefan; McKenna Jr, Edward F.; Royce, Melanie

    2008-01-01

    Combinations of capecitabine and a taxane are highly active in metastatic breast cancer, and synergy between capecitabine and docetaxel has also been demonstrated. Such combinations potentially would provide a promising non–anthracycline-based alternative for patients with early breast cancer. Non-anthracycline preoperative regimens are a particularly interesting proposition in human epidermal growth factor receptor 2 (HER2)-positive breast cancer, as they offer less cardiotoxicity and thus c...

  11. Randomised, phase II trial comparing oral capecitabine (Xeloda®) with paclitaxel in patients with metastatic/advanced breast cancer pretreated with anthracyclines

    OpenAIRE

    Talbot, D C; Moiseyenko, V; Van Belle, S; O'Reilly, S. M.; Alba Conejo, E; Ackland, S; Eisenberg, P; Melnychuk, D.; Pienkowski, T; Burger, H-U; Laws, S.; Osterwalder, B

    2002-01-01

    Capecitabine, an oral fluoropyrimidine carbamate, was designed to generate 5-fluorouracil preferentially at the tumour site. This randomised, phase II trial evaluated the efficacy and safety of capecitabine or paclitaxel in patients with anthracycline-pretreated metastatic breast cancer. Outpatients with locally advanced and/or metastatic breast cancer whose disease was unresponsive or resistant to anthracycline therapy were randomised to 3-week cycles of intermittent oral capecitabine (1255 ...

  12. Preliminary results of capecitabine metronomic chemotherapy in operable triple-negative breast cancer after standard adjuvant therapy – A single-arm phase II study

    Directory of Open Access Journals (Sweden)

    Hanan Shawky

    2014-12-01

    Conclusion: One year of capecitabine metronomic therapy preceded by standard adjuvant chemotherapy, is active and well-tolerated in TNBC patients previously treated with standard adjuvant chemotherapy.

  13. Concomitant Pseudopolymorphs of 10-Deacetyl Baccatin III

    OpenAIRE

    Tatini, Lakshmi Kumar; Rao, N. Someswara; Khan, Muzaffar; Peraka, Krishna Sumanth; Reddy, K. V. S. R. Krishna

    2013-01-01

    Three new solvates [mono-dimethyl sulfoxide (mono-DMSO), mono-dimethyl acetamide (mono-DMA) and mono-dimethyl formamide (mono-DMF)] of 10-Deacetyl baccatin III, were generated by slow evaporation in DMSO, DMF, and DMSO/DMA (1:1) solvent systems respectively. Two concomitant forms mono-DMSO(a new form) and di-DMSO (a known form) were obtained in the DMSO solvent system. Yet two other concomitant forms mono-DMA (a new form) and di-DMSO (a known form) were obtained in DMSO/DMA (1:1) solvent syst...

  14. Clinical evidence for overcoming capecitabine resistance in a woman with breast cancer terminating in radiologically occult micronodular pseudo-cirrhosis with portal hypertension: a case report

    Directory of Open Access Journals (Sweden)

    Park Yong

    2010-04-01

    Full Text Available Abstract Introduction We report a case of stage IV breast cancer terminating in an unusual picture of radiologically occult micronodular pseudo-cirrhosis. Contrast-enhanced computed tomography showed no evidence of metastatic breast cancer within the liver. Unlike the few previously reported cases of intrasinusoidal spread of breast cancer, our patient was palliated with a transjugular intrahepatic portosystemic shunt along with salvage chemohormonal therapy. In addition, our patient demonstrated proof of the principle of the dependence of capecitabine (Xeloda efficacy on dose scheduling as predicted by laboratory studies based on Gompertzian tumor growth and the Norton-Simon hypothesis. Case presentation We report the case of a 52-year-old Caucasian woman who developed radiological signs of portal hypertension without radiological evidence of hepatic metastasis five years after being diagnosed with metastatic breast cancer. She was receiving chemotherapy for stage IV breast cancer initially thought to be metastatic only to the bones. During salvage therapy with high-dose estradiol (Estradiol valerate, vinorelbine (Navelbine and bevacizumab (Avastin, she suddenly developed signs of portal hypertension confirmed on computed tomography and by portal and systemic venous pressure measurements. Drug toxicity due to bevacizumab (Avastin was initially and incorrectly entertained as a cause. The patient underwent palliative transjugular intrahepatic portosystemic shunt and transhepatic venous liver biopsy, which revealed the presence of rapidly progressive and uncontrolled metastatic breast cancer. The new discovery of radiologically occult intrasinusodal hepatic metastases with secondary micronodular cirrhosis was found to be the cause of her sudden onset portal hypertension. The patient's resistance to capecitabine (Xeloda was reversed by changing the schedule of medication to biweekly 7/7 (7 days ingesting drug alternating with 7 days off drug from

  15. 卡培他滨的合成工艺改进%Improved synthesis of capecitabine

    Institute of Scientific and Technical Information of China (English)

    潘瑜群; 陈国华; 江传亮; 李素义

    2011-01-01

    目的 改进抗肿瘤药物卡培他滨的合成工艺.方法 以5-氟胞嘧啶为原料,经硅醚化后,与5’-脱氧-1’,2’,3’-三-乙酰基-D-核糖缩合,再经酰胺化、水解制得卡培他滨.结果与结论 目标化合物的结构经1H-NMR、IR、MS谱确证,总收率为70.0%,改进后的工艺,简化了实验操作,解决了重金属超标问题,有利于工业化生产.%Capecitabine,an antitumor agent,has been used for the treatment of breast cancer or rectal cancer caused by cancer cell. To improve the synthetic procedure of capecitabine, a confluent synthetic route was designed and used to prepare the target compound in this paper. The target compound, capecitabine, was fac-ilely synthesized from 5-fluorocytosine by silylation with hexamethyldisilazane,condensation with 1,2,3-tri-0-acetyl-5-deoxy-0-.D-ribose to give 2', 3'-di-O-acetyl-5'-deoxy-5-fluorocytidine, followed by amidation with n-pentyl chloroformate, and then hydrolysis with an overall yield of about 70%. The structure of capecitabine was confirmed by 1H-NMR,IR,MS. In this improve procedure,the key intermediate 4,2',3'-di-0-acetyl-5'-deoxy-5-fluorocytidine,was easy to extract by changing the catalyst for condensation. And then the target compound was synthesized by one-step-one pot. The improved process is easy for synthesis and suitable for industrial manufacturing, and able to solve the problem of heavy metals exceeding.

  16. Capecitabine Maintenance Therapy after First-Line Chemotherapy in Patients with Metastatic Colorectal Cancer

    Institute of Scientific and Technical Information of China (English)

    Yan Li; Jing Li; Ming Lu; Xi-cheng Wang; Lin Shen

    2010-01-01

    Objective:To evaluate the efficacy and toxicity of capecitabine maintenance therapy in metastatic colorectal cancer(mCRC)patients.Methods:From June 2001 to November 2006,after they had achieved clinical response from first-line chemotherapy,patients with mCRC in our hospital received two different treatment strategies.Thirty-three patients non-maintenance group did not receive any further chemotherapy.Results:Patients in maintenance group and non-maintenance group both received FOLFOX,FOLFIRI and XELOX as first-line therapy.The median chemotherapy cycles the two groups received were the same(6 vs 6).The response rates of first-line chemotherapy were 33.3% in maintenance group and 32.7% in non-maintenance group.Patients in maintenance group received 3-9 cycles of capecitabine therapy(median cycle 4).29/33(87.9%)patients in maintenance group and 47/52(90.4%)in non-maintenance group received following second-line chemotherapy,and no patients underwent targeted therapy.The median survival time and TTP were 40.4 months(95%CI:24.2-56.6)and 9.0 months(95%CI:6.7-11.3)in maintenance group,as compared with 21.5 months(95%CI:14.9-28.0,P=0.015)and 6.5 months(95%CI:4.4-8.5,P=0.007)in non-maintenance group.No severe adverse event was observed in the capecitabine maintenance group.Conclusion:mCRC patients could benefit from capecitabine maintenance therapy by prolonging survival time and TTP.

  17. Update on capecitabine alone and in combination regimens in colorectal cancer patients.

    Science.gov (United States)

    Silvestris, N; Maiello, E; De Vita, F; Cinieri, S; Santini, D; Russo, A; Tommasi, S; Azzariti, A; Numico, G; Pisconti, S; Petriella, D; Lorusso, V; Millaku, A; Colucci, G

    2010-11-01

    Capecitabine is an orally administered fluoropyrimidine carbamate which has been developed as a prodrug of 5-FU with the goal to improve its tolerability and intratumoral drug concentration. The review aims to provide an evidence-based update of clinical trials investigating the clinical efficacy, adverse-event profile, dosage and administration of this drug, alone or in combination with conventional chemotherapeutics and/or new target-oriented drugs, in the management of colorectal cancer patients. PMID:21129610

  18. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    International Nuclear Information System (INIS)

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m2 to 825 mg/m2 orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation

  19. Clinical Efficacy of Capecitabine and Cyclophosphamide (XC) in Patients with Metastatic Breast Cancer

    OpenAIRE

    Shien, Tadahiko; Doihara, Hiroyoshi; Nishiyama,Keiko; Masuda, Hiroko; Nogami, Tomohiro; Ikeda, Hirokuni; Taira, Naruto

    2011-01-01

    Combined low-dose therapy of oral capecitabine (Xeloda) and cyclophosphamide (XC) has been demonstrated to be useful for long-term control of lesions in patients with metastatic breast cancer (MBC) and is aimed at symptomatic alleviation and prolongation of survival. Here, a retrospective review was conducted of MBC patients administered XC at the Okayama University Hospital (OUH), to evaluate responses to XC, adverse events and time to progression (TTP). Twenty patients with MBC received XC ...

  20. Treatment with capecitabine + bevacizumab following induction treatment with FOLFIRI + bevacizumab in metastatic colorectal carcinoma

    OpenAIRE

    Tatlı, Ali Murat; COŞKUN, HASAN ŞENOL; Uysal, Mükremin; Arslan, Deniz; Sezgin Göksu, Sema; Güenay Gündüz, Şeyda; Çakal, Selda; Bozcuk, Hakan Şat; Savaş, Burhan

    2014-01-01

    Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor, and it has been found to increase both progression-free survival and overall survival when it is combined with chemotherapeutic agents in the first-line and subsequent treatment of metastatic colorectal carcinoma. The objective of this study was to show the efficacy of maintenance treatment with capecitabine plus bevacizumab in patients with metastatic colorectal cancer who responded to treatment ...

  1. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eng, Cathy [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Maru, Dipen M. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Clemons, Marilyn V. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  2. Effects of low-dose capecitabine on Samarium-153-EDTMP therapy for painful bone metastases

    International Nuclear Information System (INIS)

    Samarium-153 (Sm-153)-EDTMP is routinely used for pain palliation in skeletal metastasis, however most patients report partial response. Many strategies have been contemplated to make radiation therapy for pain more effective, one of them being the use of radiosensitizers. Capecitabine is a chemotherapeutic drug and is routinely combined with external beam radiation to make the target more radio-sensitive. Aim of the study was to evaluate whether combining capecitabine in radiosensitizing dose with Sm-153-EDTMP produces superior analgesia compared to Sm alone. Forty-four patients with skeletal metastases from various primaries were randomized into two groups: The study group received 1 mCi/kg Sm-153-EDTMP plus capecitabine (1,650 mg/m2) orally for 8 days (equivalent to four t½ of 153Sm-EDTMP) and the control arm received 1 mCi/kg Sm-153-EDTMP plus placebo for the 8 days. After treatment, the patients were followed up for 12 weeks to evaluate the degree and duration of pain palliation and hematologic toxicity. All 44 patients reported different degrees of pain relief with none reporting complete pain relief for the entire duration of 12 weeks posttherapy observation period. However the level of pain relief obtained in study arm was significantly better than the control arm with mean posttherapy pain score being 1.29 ± 1.05 and 3.59 ± 2.77 respectively with P of 0.001. Transient and mild hematologic toxicity, as determined by World Health Organization criteria, was apparent in both arms without significant differences. The addition of a low-dose of capecitabine significantly enhances the analgesic effect of Sm-153 without any additional side effects

  3. Capecitabine-induced cardiotoxicity: more evidence or clinical approaches to protect the patients' heart?

    Directory of Open Access Journals (Sweden)

    Fontanella C

    2014-09-01

    Full Text Available Caterina Fontanella,1 Marianna Aita,1 Marika Cinausero,1 Giuseppe Aprile,1 Maria Grazia Baldin,2 Veronica Dusi,3 Chiara Lestuzzi,4 Gianpiero Fasola,1 Fabio Puglisi1,5 1Department of Oncology, University Hospital of Udine, Udine, Italy; 2Department of Cardiology, Palmanova General Hospital, Palmanova, Italy; 3Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 4Department of Cardiology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy; 5Department of Medical and Biological Sciences, University of Udine, Udine, Italy Abstract: Fluoropyrimidines, such as capecitabine and 5-fluorouracil, may cause cardiac toxicity. In recent years, the incidence of this side effect has increased and it is expected to further rise due to the population aging and the disproportionate incidence of breast and gastrointestinal cancers in older individuals. The spectrum of cardiac manifestations includes different signs and symptoms and the diagnosis may be difficult. Here, we report the case of a 43-year-old woman with advanced breast cancer who was rechallenged with a capecitabine-based regimen after experiencing a cardiac adverse event during the first fluoropyrimidine exposure. This real-practice case serves as a springboard for discussion about the current evidence on differential diagnosis of capecitabine-related cardiac toxicity, its risk factors, and the underpinning mechanisms of early onset. Moreover, we discussed whether a rechallenge with fluoropyrimidines could be safe in patients who had experienced a previous cardiac adverse event. Keywords: risk factors, clinical manifestation, rechallenge

  4. Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness

    Science.gov (United States)

    Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo

    2010-01-01

    Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful. PMID:22798096

  5. Safety, pharmacokinetics, and pharmacodynamics of the DR5 antibody LBY135 alone and in combination with capecitabine in patients with advanced solid tumors

    NARCIS (Netherlands)

    Sharma, Sunil; de Vries, Elisabeth G. E.; Infante, Jeffrey R.; Oldenhuis, Corina N.; Gietema, Jourik A.; Yang, Lin; Bilic, Sanela; Parker, Katie; Goldbrunner, Michael; Scott, Jeffrey W.; Burris, Howard A.

    2014-01-01

    Purpose We evaluated the safety, maximum tolerated dose (MTD), pharmacokinetics, pharmacodynamics, biologic activity, and antitumor efficacy of the DR5 antibody, LBY135 +/- capecitabine. Experimental design Escalating LBY135 was administered every 21 days, alone (Arm1) or with capecitabine (Arm2), t

  6. Capecitabine combined with weekly docetaxel in Chinese patients >65 years with anthracycline-resistant metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    WANG Hua-qing; XIE Cong-hua; QIAN Zheng-zi; LIU Xian-ming; ZHANG Hui-lai; LI Lan-fang; QIU Li-hua; HOU Yun; ZHOU Shi-yong; HAO Xi-shan

    2010-01-01

    Background There are no data on more tolerable capecitabine doses in elderly patients in Chinese population. The aim of this study was to evaluate the activity and safety of capecitabine combined with weekly docetaxel for the treatment of anthracycline-resistant metastatic breast cancer (MBC) in older Chinese patients.Methods MBC patients aged >65 years pretreated with 1-5 prior chemotherapy regimens, including an anthracycline,received oral capecitabine 825 mg/m2 twice daily, days 1-14, plus docetaxel30 mg/m2 on days 1 and 8 every 21 days. All 41 enrolled patients received at least 1 dose of treatment and were evaluable for safety; 38 received at least 2 cycles (median 4, range 2-8) and were evaluable for efficacy.Results The overall objective response rate was 47%, including complete responses in 8% of patients. Median time to progression was 8.9 months. Median overall survival was 17.6 months. The most common side effects were haematological and gastrointestinal toxicities and hand-foot syndrome. The only grade 3/4 adverse events were neutropenia (12%), alopecia (7%), grade 3 nausea and vomiting (2%) and grade 3 nail toxicity (2%).Conclusions Capecitabine 825 mg/m2 twice daily plus weekly docetaxel is active with an acceptable safety profile in Chinese women >65 years with anthracycline-resistant MBC. Efficacy and tolerability compare favourably with previously reported trials evaluating higher capecitabine doses in combination with 3-weekly or weekly docetaxel.

  7. Efficacy Endpoints of Radiation Therapy Group Protocol 0247: A Randomized, Phase 2 Study of Neoadjuvant Radiation Therapy Plus Concurrent Capecitabine and Irinotecan or Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Stuart J. [Medical College of Wisconsin, Madison, Wisconsin (United States); Moughan, Jennifer [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Meropol, Neal J., E-mail: Neal.Meropol@case.edu [University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio (United States); Anne, Pramila Rani [Department of Radiation Oncology and Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Kachnic, Lisa A. [Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts (United States); Rashid, Asif [Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Watson, James C. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Mitchell, Edith P. [Department of Radiation Oncology and Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Pollock, Jondavid [The Schiffler Cancer Center, Wheeling, West Virginia (United States); Lee, R. Jeffrey [Intermountain Medical Center, Murray, Utah (United States); Haddock, Michael [Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Erickson, Beth A. [Medical College of Wisconsin, Madison, Wisconsin (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2015-01-01

    Purpose: To report secondary efficacy endpoints of Radiation Therapy Oncology Group protocol 0247, primary endpoint analysis of which demonstrated that preoperative radiation therapy (RT) with capecitabine plus oxaliplatin achieved a pathologic complete remission prespecified threshold (21%) to merit further study, whereas RT with capecitabine plus irinotecan did not (10%). Methods and Materials: A randomized, phase 2 trial evaluated preoperative RT (50.4 Gy in 1.8-Gy fractions) with 2 concurrent chemotherapy regimens: (1) capecitabine (1200 mg/m{sup 2}/d Monday-Friday) plus irinotecan (50 mg/m{sup 2}/wk × 4); and (2) capecitabine (1650 mg/m{sup 2}/d Monday-Friday) plus oxaliplatin (50 mg/m{sup 2}/wk × 5) for clinical T3 or T4 rectal cancer. Surgery was performed 4 to 8 weeks after chemoradiation, then 4 to 6 weeks later, adjuvant chemotherapy (oxaliplatin 85 mg/m{sup 2}; leucovorin 400 mg/m{sup 2}; 5-fluorouracil 400 mg/m{sup 2}; 5-fluorouracil 2400 mg/m{sup 2}) every 2 weeks × 9. Disease-free survival (DFS) and overall survival (OS) were estimated univariately by the Kaplan-Meier method. Local–regional failure (LRF), distant failure (DF), and second primary failure (SP) were estimated by the cumulative incidence method. No statistical comparisons were made between arms because each was evaluated individually. Results: A total of 104 patients (median age, 57 years) were treated; characteristics were similar for both arms. Median follow-up for RT with capecitabine/irinotecan arm was 3.77 years and for RT with capecitabine/oxaliplatin arm was 3.97 years. Four-year DFS, OS, LRF, DF, and SP estimates for capecitabine/irinotecan arm were 68%, 85%, 16%, 24%, and 2%, respectively. The 4-year DFS, OS, LRF, DF, and SP failure estimates for capecitabine/oxaliplatin arm were 62%, 75%, 18%, 30%, and 6%, respectively. Conclusions: Efficacy results for both arms are similar to other reported studies but suggest that pathologic complete remission is an

  8. Efficacy Endpoints of Radiation Therapy Group Protocol 0247: A Randomized, Phase 2 Study of Neoadjuvant Radiation Therapy Plus Concurrent Capecitabine and Irinotecan or Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    International Nuclear Information System (INIS)

    Purpose: To report secondary efficacy endpoints of Radiation Therapy Oncology Group protocol 0247, primary endpoint analysis of which demonstrated that preoperative radiation therapy (RT) with capecitabine plus oxaliplatin achieved a pathologic complete remission prespecified threshold (21%) to merit further study, whereas RT with capecitabine plus irinotecan did not (10%). Methods and Materials: A randomized, phase 2 trial evaluated preoperative RT (50.4 Gy in 1.8-Gy fractions) with 2 concurrent chemotherapy regimens: (1) capecitabine (1200 mg/m2/d Monday-Friday) plus irinotecan (50 mg/m2/wk × 4); and (2) capecitabine (1650 mg/m2/d Monday-Friday) plus oxaliplatin (50 mg/m2/wk × 5) for clinical T3 or T4 rectal cancer. Surgery was performed 4 to 8 weeks after chemoradiation, then 4 to 6 weeks later, adjuvant chemotherapy (oxaliplatin 85 mg/m2; leucovorin 400 mg/m2; 5-fluorouracil 400 mg/m2; 5-fluorouracil 2400 mg/m2) every 2 weeks × 9. Disease-free survival (DFS) and overall survival (OS) were estimated univariately by the Kaplan-Meier method. Local–regional failure (LRF), distant failure (DF), and second primary failure (SP) were estimated by the cumulative incidence method. No statistical comparisons were made between arms because each was evaluated individually. Results: A total of 104 patients (median age, 57 years) were treated; characteristics were similar for both arms. Median follow-up for RT with capecitabine/irinotecan arm was 3.77 years and for RT with capecitabine/oxaliplatin arm was 3.97 years. Four-year DFS, OS, LRF, DF, and SP estimates for capecitabine/irinotecan arm were 68%, 85%, 16%, 24%, and 2%, respectively. The 4-year DFS, OS, LRF, DF, and SP failure estimates for capecitabine/oxaliplatin arm were 62%, 75%, 18%, 30%, and 6%, respectively. Conclusions: Efficacy results for both arms are similar to other reported studies but suggest that pathologic complete remission is an unsuitable surrogate for traditional survival

  9. Phase I study of intermittent and chronomodulated oral therapy with capecitabine in patients with advanced and/or metastatic cancer

    International Nuclear Information System (INIS)

    The combination of capecitabine and gemcitabine at Fixed Dose Rate (FDR) has been demonstrated to be well tolerated, with apparent efficacy in patients with advanced cancers. FDR gemcitabine infusion leads to enhanced intracellular accumulation of drug and possible augmented clinical effect. The goals of this phase I study were to determine the maximum-tolerated dose (MTD) of chronomodulated capecitabine in patients with advanced cancer and to describe the dose-limiting toxicities (DLT), the safety profile of this way of administration. Patients with advanced solid tumours who had failed to response to standard therapy or for whom no standard therapy was available were elegible for this study. Capecitabine was administered orally according to following schedule: 1/4 of dose at 8:00 a.m.; 1/4 of dose at 6:00 p.m. and 1/2 of dose at 11:00 p.m. each day for 14 consecutive days, followed by a 7-day rest period. All 27 patients enrolled onto the study were assessable for toxicity. The most common toxicities during the first two cycles of chemotherapy were fatigue, diarrhoea and hand foot syndrome (HFS). Only one out of the nine patients treated at capecitabine dose of 2,750 mg/m2 met protocol-specified DLT criteria (fatigue grade 4). However, at these doses the majority of cycles of therapy were delivered without dose reduction or delay. No other episodes of DLT were observed at the same dose steps and at the lower dose steps of capecitabine (1,500/1,750/2,000/2,250/2,500 mg/m2). The dose of 2,750 mg/m2 is recommended for further study. Tumor responses were observed in patients with metastatic breast and colorectal cancer. High doses of chronomodulated capecitabine can be administered with acceptable toxicity. The evidence of antitumor activity deserves further investigation in phase II combination chemotherapy studies

  10. Predictive value of MSH2 gene expression in colorectal cancer treated with capecitabine

    DEFF Research Database (Denmark)

    Jensen, Lars H; Danenberg, Kathleen D; Danenberg, Peter V; Jakobsen, Anders

    2007-01-01

    PURPOSE: The objective of the present study was to evaluate the gene expression of the DNA mismatch repair gene MSH2 as a predictive marker in advanced colorectal cancer (CRC) treated with first-line capecitabine. PATIENTS AND METHODS: Microdissection of paraffin-embedded tumor tissue, RNA...... extraction, and quantitative polymerase chain reaction were performed on tumors obtained from 37 patients with advanced CRC. RESULTS: The median relative gene expression of MSH2 was 0.65 (quartiles 0.5-0.8) in nonresponders and 1.25 (quartiles 0.92-1.38) for responders (P = 0.038). High expression of MSH2...

  11. Capecitabine with radiation is an effective adjuvant therapy in gastric cancers

    Institute of Scientific and Technical Information of China (English)

    Chee; Kian; Tham; Su; Pin; Choo; Donald; Yew; Hee; Poon; Han; Chong; Toh; Simon; Yew; Kuang; Ong; Sze; Huey; Tan; Michael; Lian; Chek; Wang; Kian; Fong; Foo

    2010-01-01

    AIM:To analyze the outcome of patients who received concurrent capecitabine(Xeloda) and radiation(XRT) compared to the established concurrent 5-fluorouracil(5-FU) with radiation(5FU-RT) and fluoropyrimidine-based chemotherapy alone as adjuvant treatment in gastric cancers.METHODS:All patients with gastric cancers who received adjuvant treatment at the National Cancer Centre Singapore between 1996 and 2006 were reviewed.Treatment outcomes of patients who received XRT were compared with those who had 5FU-RT o...

  12. Cytotoxicity and genotoxicity of capecitabine in head and neck cancer and normal cells

    OpenAIRE

    Wisniewska-Jarosinska, Maria; Sliwinski, Tomasz; Kasznicki, Jacek; Kaczmarczyk, Dariusz; Krupa, Renata; Bloch, Karolina; Drzewoski, Jozef; Chojnacki, Jan; Blasiak, Janusz; Morawiec-Sztandera, Alina

    2010-01-01

    The interaction between a chemical and a cell may strongly depend on whether this cell is normal or pathological. Side effects of anticancer drugs may sometimes overcome their benefit action, so it is important to investigate their effect in both the target and normal cells. Capecitabine (Xeloda, CAP), a prodrug of 5-fluorouracil, is mainly used in colon cancer, but little is known about its action in head and neck cancer. We compared the cyto- and genotoxicity of CAP in head and neck HTB-43 ...

  13. Clinical efficacy of including capecitabine in neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Qiuyun Li

    Full Text Available BACKGROUND: Capecitabine has proven effective as a chemotherapy for metastatic breast cancer. Though several Phase II/III studies of capecitabine as neoadjuvant chemotherapy have been conducted, the results still remain inconsistent. Therefore, we performed a meta-analysis to obtain more precise understanding of the role of capecitabine in neoadjuvant chemotherapy for breast cancer patients. METHODS: The electronic database PubMed and online abstracts from ASCO and SABCS were searched to identify randomized clinical trials comparing neoadjuvant chemotherapy with or without capecitabine in early/operable breast cancer patients without distant metastasis. Risk ratios were used to estimate the association between capecitabine in neoadjuvant chemotherapy and various efficacy outcomes. Fixed- or random-effect models were adopted to pool data in RevMan 5.1. RESULTS: Five studies were included in the meta-analysis. Neoadjuvant use of capecitabine with anthracycline and/or taxane based therapy was not associated with significant improvement in clinical outcomes including: pathologic complete response in breast (pCR; RR = 1.10, 95% CI 0.87-1.40, p = 0.43, pCR in breast tumor and nodes (tnpCR RR = 0.99, 95% CI 0.83-1.18, p = 0.90, overall response rate (ORR; RR = 1.00, 95% CI 0.94-1.07, p = 0.93, or breast-conserving surgery (BCS; RR = 0.98, 95% CI 0.93-1.04, p = 0.49. CONCLUSIONS: Neoadjuvant treatment of breast cancer involving capecitabine did not significantly improve pCR, tnpCR, BCS or ORR. Thus adding capecitabine to neoadjuvant chemotherapy regimes is unlikely to improve outcomes in breast cancer patients without distant metastasis. Further research is required to establish the condition that capecitabine may be useful in breast cancer neoadjuvant chemotherapy.

  14. Concomitant pituitary adenoma and Rathke's cleft cyst

    International Nuclear Information System (INIS)

    We reviewed the clinical, radiological and surgical findings in patients with both pituitary adenoma and Rathke's cleft cyst. We retrospectively selected patients with both lesions from the 374 patients in whom a sellar/juxtasellar lesion was detected on MRI at 1.5 tesla. All patients received intravenous contrast medium. Concomitant pituitary adenoma and Rathke's cleft cyst were found in eight patients (2.1 %). The frequency of the combination was 3.5 % of pituitary adenomas and 11 % of Rathke's cleft cysts. Symptoms were always due to the adenoma, secreting adrenocorticotrophin in two patients and growth hormone in six. The adenoma was larger in five patients, and the cyst in three. The cysts gave variable signal. The adenoma was adjacent to the cyst in seven patients, and enclosed it in the other patient. As a result of experience with MRI, concomitant pituitary adenoma and Rathke's cleft cyst are now known not to be as rare as thought previously. When a nonenhancing cyst-like structure is demonstrated in a patient with pituitary adenoma, the possibility of a coexisting Rathke's cleft cyst should be considered. (orig.)

  15. Pharmacokinetics and pharmacogenetics of capecitabine and its metabolites following replicate administration of two 500 mg tablet formulations

    NARCIS (Netherlands)

    Queckenberg, C.; Erlinghagen, V.; Baken, B.C.; Os, S.H. Van; Wargenau, M.; Kubes, V.; Peroutka, R.; Novotny, V.M.; Fuhr, U.

    2015-01-01

    PURPOSE: To describe concentration versus time profiles of capecitabine and its metabolites 5'-DFUR, 5'-DFCR and 5-FU, depending on tablet formulation and on frequent and/or relevant genetic polymorphisms of cytidine deaminase, dihydropyrimidine dehydrogenase, thymidylate synthase and methylenetetra

  16. Lapatinib in combination with capecitabine in the management of ErbB2-positive (HER2-positive advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Bella Kaufman

    2008-03-01

    Full Text Available Bella Kaufman1, Steven Stein2, Michelle A Casey2, Beth O Newstat21Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2GlaxoSmithKline, Collegeville, PA, USAAbstract: Lapatinib is an oral, reversible, dual inhibitor of epidermal growth factor receptor ErbB1 (EGFR and human epidermal growth factor receptor type 2 ErbB2 (HER2. Results of a phase III study comparing lapatinib plus capecitabine with capecitabine alone in women with ErbB2-overexpressing advanced breast cancer previously treated with an anthracycline, a taxane, and trastuzumab were reported early based on superiority of the combination in prolonging time to tumor progression (TTP. An updated analysis in 399 women supports the earlier findings. In this updated analysis, TTP (hazard ratio [HR] 0.57 favored lapatinib plus capecitabine. Survival trended in favor of the combination. The incidence of cardiac events was numerically higher in the combination arm (5 cases in the combination arm, 2 cases in the monotherapy arm.Keywords: lapatinib, capecitabine, breast cancer, HER2

  17. Capecitabine metronomic chemotherapy inhibits the proliferation of gastric cancer cells through anti-angiogenesis.

    Science.gov (United States)

    Yuan, Fei; Shi, Hailong; Ji, Jun; Cai, Qu; Chen, Xuehua; Yu, Yingyan; Liu, Bingya; Zhu, Zhenggang; Zhang, Jun

    2015-04-01

    To evaluate the inhibitory effect and mechanism of capecitabine metronomic chemotherapy on gastric cancer cells. In vitro, the effects of 5-fluorouracil (Fu) metronomic chemotherapy on proliferation, apoptosis, tube formation ability, and angiogenesis were detected. In vivo, Ki-67, CD34 and VEGF were detected by immunohistochemical staining (IHC). Flow cytometry was used to detect the percentage of circulating endothelial progenitors (CEPs), and VEGF and PDGF were detected by ELISA in the peripheral blood of nude mice. The proliferation of the SGC-7901 and AGS gastric cancer cell lines in the metronomic 5-Fu group was decreased compared with the control group in vitro. The total length of the small tubes and tubular junction numbers were significantly lower in the metronomic group than the control group. The VEGF and PDGF levels in the cell culture supernatants were lower in the metronomic group than the control group. Compared with the control group, the CEP percentage was decreased in the peripheral blood of tumor-bearing nude mice following treatment with metronomic 5-Fu or capecitabine chemotherapy. No significant changes were found in the conventional or control group. In the peripheral blood of tumor-bearing nude mice, the VEGF and PDGF levels were decreased in the metronomic groups. Metronomic 5-Fu inhibited the proliferation of gastric cancer cells in vitro and in vivo, and their antitumor effects were non-inferior to those of conventional dose chemotherapy, with mild side effects. Thus, tumor inhibition may be attributed to anti-angiogenesis. PMID:25634241

  18. Progressive thrombosis after treatment of diffuse large cell non-Hodgkin's lymphoma and concomitant lupus anticoagulant.

    Science.gov (United States)

    Keung, Y K; Cobos, E; Meyerrose, G E; Roberson, G H

    1996-01-01

    We report a case of diffuse large cell non-Hodgkin's lymphoma with concomitant lupus anticoagulant at initial diagnosis. Progressive thrombosis occurred despite radiologically proven response of the lymphoma after chemotherapy treatment. Extraordinary bone scintigraphy with multiple "cold" lesions probably due to bone ischemia is described. PMID:8624478

  19. Superselective arterial infusion and concomitant radiotherapy

    International Nuclear Information System (INIS)

    Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1). During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, methicillin-resistant staphylococcus aureus (MRSA) pneumonia, sepsis, tetraplasia, and osteoradionecrosis. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed. (author)

  20. Superselective arterial infusion and concomitant radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Homma, Akihiro; Suzuki, Fumiyuki; Inuyama, Yukio; Fukuda, Satoshi [Hokkaido Univ., Sapporo (Japan). School of Medicine

    2003-05-01

    Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m{sup 2}/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1). During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, methicillin-resistant staphylococcus aureus (MRSA) pneumonia, sepsis, tetraplasia, and osteoradionecrosis. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed. (author)

  1. Patterns of Response After Preoperative Intensity-Modulated Radiation Therapy and Capecitabine/Oxaliplatin in Rectal Cancer: Is There Still a Place for Ecoendoscopic Ultrasound?

    International Nuclear Information System (INIS)

    Purpose: The main goals of preoperative chemoradiotherapy (CHRT) in rectal cancer are to achieve pathological response and to ensure tumor control with functional surgery when possible. Assessment of the concordance between clinical and pathological responses is necessary to make decisions regarding alternative conservative procedures. The present study evaluates the patterns of response after a preoperative CHRT regimen, and the value of endoscopic ultrasound (EUS) in assessing response. Methods and Materials: A total of 51 EUS-staged T3 to T4 and/or N0 to N+ rectal cancer patients received preoperative CHRT (intensity-modulated radiation therapy and capecitabine/oxaliplatin (XELOX) followed by radical resection. Clinical response was assesed by EUS. Rates of pathological tumor regression grade (TRG) and lymph node (LN) involvement were determined in the surgical specimen. Clinical and pathological responses were compared, and the accuracy of EUS in assessing response was calculated. Results: Twenty-four patients (45%) achieved a major pathological response (complete or >95% pathological response (TRG 3+/4)). Sensitivity, specificity, negative predictive value, and positive predictive value of EUS in predicting pathological T response after preoperative CHRT were 77.8%, 37.5%, 60%, and 58%, respectively. The EUS sensitivity, specificity, negative predictive value, and positive predictive value for nodal staging were 44%, 88%, 88%, and 44%, respectively. Furthermore, EUS after CHRT accurately predicted the absence of LN involvement in 7 of 7 patients (100%) with major pathological response of the primary tumor. Conclusion: Preoperative IMRT with concomitant XELOX induces favorable rates of major pathological response. EUS has a limited ability to predict primary tumor response after preoperative CHRT, but it is useful for accurately determining LN status. EUS may have a potential value in identifying patients with a very low risk of LN involvement in association

  2. Combination therapies with oxaliplatin and oral capecitabine or intravenous 5-FU show similar toxicity profiles in gastrointestinal carcinoma patients if hand-food syndrome prophylaxis is performed continuously

    OpenAIRE

    Wehler, Thomas C.; Cao, Yang; Peter R. Galle; Theobald, Matthias; Moehler, Markus; Schimanski, Carl C

    2012-01-01

    The use of anticancer drugs in palliative settings is often limited by their severe toxic effects. In gastrointestinal carcinomas the 5-fluorouracil-based palliative regimen FOLFOX-4 is often preferred to the equally effective, but more convenient oral capecitabine-based regimen XELOX. This preference is mainly based on the fact that the highly effective oral agent capecitabine induces hand-foot syndrome (HFS). In this study, we investigated whether the continuous administration of skin proph...

  3. Genomic alterations in DNA repair and chromatin remodeling genes in estrogen receptor-positive metastatic breast cancer patients with exceptional responses to capecitabine

    International Nuclear Information System (INIS)

    We analyzed the genomic and phosphoproteomic profiles of breast cancer tissue obtained from six patients with estrogen receptor (ER)-positive, HER2-negative metastatic breast cancer who had highly durable (≥5 years) and, in some cases, ongoing clinical responses with capecitabine. Formalin-fixed, paraffin-embedded tissue samples from patients’ primary (n = 4) or metastatic (n = 2) breast cancers were utilized for targeted next-generation sequencing and reversed phase protein microarray. Two patients received capecitabine monotherapy. Four patients received capecitabine in combination with paclitaxel; three of these continued single-agent capecitabine after stopping paclitaxel. Capecitabine was discontinued for progressive disease after a mean of 66 months in four patients (range 54–86 months), and two patients remain on therapy, having received capecitabine for >91 months and >122 months, respectively. Three patients’ cancers (50%) had likely functional alterations in DNA repair and chromatin remodeling genes, while three other patients’ cancers had variants of unknown significance in these pathways. Mutations in PIK3CA, amplifications of FGFR1 or ZNF703, or phosphorylation of HER family receptors and their downstream proteins did not preclude exceptional responses to capecitabine. None of the patients’ tumors harbored TP53 or PTEN mutations. Four of the patients had breast cancer tissue available for PTEN immunohistochemistry, and all four patients’ cancers were positive for PTEN. These surprising findings in a group of phenotypically similar patients with ER-positive, endocrine therapy-pretreated, HER2-negative metastases, are supported by preclinical data showing that sensitivity to 5-fluorouracil is enhanced by deficiencies in chromatin remodeling and homologous recombination genes. Our findings suggest that mutations that inactivate homologous recombination and/or chromatin remodeling genes within ER-positive, HER2-negative breast cancers may

  4. Pharmacoeconomic analysis of adjuvant oral capecitabine vs intravenous 5-FU/LV in Dukes' C colon cancer: the X-ACT trial

    OpenAIRE

    Cassidy, J.; Douillard, J.Y.; Twelves, C.; McKendrick, J.J.; Scheithauer, W.; Bustová, I.; Johnston, P G; Lesniewski-Kmak, K; Jelic, S; Fountzilas, G.; Coxon, F.; Díaz-Rubio, E.; Maughan, T.S.; Malzyner, A.; Bertetto, O.

    2006-01-01

    Oral capecitabine (Xeloda®) is an effective drug with favourable safety in adjuvant and metastatic colorectal cancer. Oxaliplatin-based therapy is becoming standard for Dukes' C colon cancer in patients suitable for combination therapy, but is not yet approved by the UK National Institute for Health and Clinical Excellence (NICE) in the adjuvant setting. Adjuvant capecitabine is at least as effective as 5-fluorouracil/leucovorin (5-FU/LV), with significant superiority in relapse-free sur...

  5. A phase I clinical and pharmacokinetic study of capecitabine (Xeloda®) and irinotecan combination therapy (XELIRI) in patients with metastatic gastrointestinal tumours

    OpenAIRE

    Delord, J P; Pierga, J Y; Dieras, V; Bertheault-Cvitkovic, F; Turpin, F L; Lokiec, F.; Lochon, I; Chatelut, E; Canal, P.; Guimbaud, R; Mery-Mignard, D; Cornen, X; Mouri, Z; Bugat, R

    2005-01-01

    Capecitabine is a highly active oral fluoropyrimidine that is an attractive alternative to 5-fluorouracil in colorectal cancer treatment. The current study, undertaken in 27 patients with gastrointestinal tumours, aimed to assess the toxicity and potential for significant pharmacokinetic interactions of a combination regimen incorporating capecitabine with 3-weekly irinotecan (XELIRI). Irinotecan (200 and 250 mg m−2) was administered as a 90-min infusion on day 1 in combination with escalatin...

  6. Individually tailored treatment with epirubicin and paclitaxel with or without capecitabine as first-line chemotherapy in metastatic breast cancer : a randomized multicenter trial

    OpenAIRE

    Hatschek, T.; Carlsson, L; Einbeigi, Z.; Lidbrink, E; Linderholm, B.; Lindh, Birgitta; Loman, N.; Malmberg, M.; Rotstein, S; Söderberg, M; Sundquist, M; Walz, TM; Hellström, M.; Svensson, H; Åström, G

    2012-01-01

    Anthracyclines and taxanes are active cytotoxic drugs in the treatment of early metastatic breast cancer. It is yet unclear whether addition of capecitabine to the combination of these drugs improves the treatment outcome. Patients with advanced breast cancer were randomized to first-line chemotherapy with a combination of epirubicin (Farmorubicin(A (R))) and paclitaxel (Taxol(A (R))) alone (ET) or in combination with capecitabine (Xeloda(A (R)), TEX). Starting doses for ET were epirubicin 75...

  7. Radiotherapy plus concomitant temozolomide in primary gliosarcoma.

    Science.gov (United States)

    Adeberg, Sebastian; Bernhardt, Denise; Harrabi, Semi Ben; Diehl, Christian; Koelsche, Christian; Rieken, Stefan; Unterberg, Andreas; von Deimling, Andreas; Debus, Juergen

    2016-06-01

    Clinical guidelines for gliosarcoma (GSM) are poorly defined and GSM patients are usually treated in accordance with existing guidelines for glioblastoma (GBM), with maximal surgical resection followed by chemoradiation with temozolomide (TMZ). However, it is not clear yet if GSM patients profit from TMZ therapy and if O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation is crucial. We retrospectively evaluated 37 patients with histologically proven, primary GSM who had received radiation therapy since the temozolomide era (post-2005). Twenty-five patients (67.6 %) received combined chemoradiation with temozolomide, and 12 cases (32.4 %) received radiation therapy alone. Molecular markers were determined retrospectively. Survival and correlations were calculated using log-rank, univariate, and multivariate Cox proportional hazards-ratio analyses. All cases were isocitrate dehydrogenase 1 (IDH1) wildtype, MGMT promoter methylation could be observed in 33.3 % of the assessable cases (10/30) and TERT promoter mutation was seen in a high frequency of 86.7 % (26/30). The influence of TMZ therapy on overall survival (OS) was significantly improved compared with cases in which radiation therapy alone was performed (13.9 vs. 9.9 months; p = 0.045), independently of MGMT promoter methylation. The positive effect of TMZ on OS was confirmed in this study's multivariate analyses (p = 0.04), after adjusting our results for potential confounders. In conclusion, this study demonstrates that concomitant TMZ together with radiation therapy increases GSM-patient survival independent of MGMT promoter methylation. Thus, GSM can be treated in accordance to GBM guidelines. MGMT promoter methylation was infrequent and TERT promoter mutation common without influencing the survival rates. The mechanisms of TMZ effects in GSM are still not fully understood and merit further clinical and molecular-genetic and -biological evaluation. PMID:27025857

  8. First efficacy results of capecitabine with anthracycline- and taxane-based adjuvant therapy in high-risk early breast cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yiwei Jiang

    Full Text Available BACKGROUND: Capecitabine is effective and indicated for the salvage treatment of metastatic breast cancer. Therefore, it is essential to evaluate the efficacy of capecitabine in the adjuvant setting. There have been two large randomized studies to determine whether patients with high-risk early breast cancer benefit from the addition of capecitabine to standard chemotherapy, but they have yielded inconsistent results. We first undertook a meta-analysis to evaluate the efficacy of the addition of capecitabine over standard treatment. METHODS: PubMed, EBSCO, Web of Science, conference proceedings and key trials were searched from 1998 to 2011. The hazard ratio (HR was used to evaluate the efficacy of a taxane-anthracycline regimen and a taxane-anthracycline-capecitabine regimen in early breast cancer. All of the data from each study use either fixed-effects or random-effects by Stata. FINDINGS: We found significant improvement in the additional capecitabine arm versus control in disease-free survival (DFS (HR = 0.83, 95% CI: 0.71-0.98, P = 0.027, overall survival (OS (HR = 0.71, 95% CI: 0.57-0.88, P = 0.002, distant recurrence (HR = 0.79, 95% CI: 0.66-0.94, P = 0.008 and the death from breast cancer only (HR = 0.65, 95% CI: 0.51-0.83, P = 0.001. Meanwhile, the subgroup analysis revealed that capecitabine improved the DFS in triple negative (HR = 0.71, 95% CI: 0.53-0.96, P = 0.028, hormone receptor negative (HR = 0.73, CI: 0.56-0.94, P = 0.017 and HER2 negative (HR = 0.81, CI: 0.67-0.98, P = 0.034 patients. CONCLUSION: Due to the synergistic effect of taxane and capecitabine, taxane-anthracycline-capecitabine regimen may effectively improve the efficacy in the adjuvant setting and may be a novel generation of adjuvant chemotherapy regimen. The results of the current meta-analysis support this hypothesis and indicate that taxane-based regimen with capecitabine may be an effective, convenient

  9. Pharmacogenetics-Guided Phase I Study of Capecitabine on an Intermittent Schedule in Patients with Advanced or Metastatic Solid Tumours.

    Science.gov (United States)

    Soo, Ross Andrew; Syn, Nicholas; Lee, Soo-Chin; Wang, Lingzhi; Lim, Xn-Yii; Loh, Marie; Tan, Sing-Huang; Zee, Ying-Kiat; Wong, Andrea Li-Ann; Chuah, Benjamin; Chan, Daniel; Lim, Siew-Eng; Goh, Boon-Cher; Soong, Richie; Yong, Wei-Peng

    2016-01-01

    The FDA-approved starting dosage of capecitabine is 1,250 mg/m(2), and market research indicates that U.S. physicians routinely prescribe 1,000 mg/m(2). Retrospective analyses however report reduced toxicity and efficacy in a subset of patients with the 3R/3R genotype of the thymidylate synthase gene enhancer region (TSER). This study sought to develop TSER genotype-specific guidelines for capecitabine dosing. Capecitabine was dose-escalated in advanced and/or metastatic cancer patients with TSER 3R/3R (Group A; N = 18) or 2R/2R + 2R/3R (Group B; N = 5) from 1,250 to 1,625 mg/m(2) b.i.d., every 2 weeks on/1 week off for up to 8 cycles. Parent and metabolites pharmacokinetics, adverse events, and tumour response were assessed. The maximum tolerated and recommended doses in 3R/3R patients are 1,625 mg/m(2) and 1,500 mg/m(2). At 1,500 mg/m(2), one in nine 3R/3R patients experienced a dose-limiting toxicity. Dosing guidelines for 2R/2R + 2R/3R remain undetermined due to poor accrual. The results indicate that 3R/3R patients may be amenable to 1,500 mg/m(2) b.i.d. on an intermittent schedule, and is the first to prospectively validate the utility of TSER pharmacogenetic-testing before capecitabine treatment. PMID:27296624

  10. Compliance and Effective Management of the Hand-Foot Syndrome in Colon Cancer Patients Receiving Capecitabine as Adjuvant Chemotherapy

    OpenAIRE

    Son, Hyun-Sook; Lee, Woo Yong; Lee, Won-Suk; Yun, Seong Hyeon; Chun, Ho-Kyung

    2009-01-01

    Purpose Physicians and oncology nurses must continue to update their knowledge on treatment and treatment-related side effects, while searching for effective methods to prevent or manage side effects. The objective of our study was to describe the incidence and response to treatment of the hand-foot syndrome (HFS) and the compliance with treatment of patients with stage IIB, IIIA, IIIB, and IIIC colon cancer that were treated with capecitabine alone as adjuvant therapy. Materials and Methods ...

  11. OPTIMIZATION OF THE FORMULATION AND IN-VITRO EVALUATION OF CAPECITABINE NIOSOMES FOR THE TREATMENT OF COLON CANCER

    OpenAIRE

    B. Anbarasan , S. Rekha, K. Elango , B. Shriya and S. Ramaprabhu*

    2013-01-01

    ABSTRACT: The goal of the present study was to investigate the feasibility of using non-ionic surfactant vesicles as carriers for the sustained delivery of water soluble anti-cancer drug Capecitabine, used in the treatment of colorectal cancer. The niosomal formulations were prepared using various non-ionic surfactants (span 40, span 60, tween 40 and tween 60) in the presence of cholesterol, by thin film hydration technique. The effect of process related variables like hydration time, sonicat...

  12. OPTIMIZATION OF THE FORMULATION AND IN-VITRO EVALUATION OF CAPECITABINE NIOSOMES FOR THE TREATMENT OF COLON CANCER

    Directory of Open Access Journals (Sweden)

    B. Anbarasan , S. Rekha, K. Elango , B. Shriya and S. Ramaprabhu*

    2013-04-01

    Full Text Available ABSTRACT: The goal of the present study was to investigate the feasibility of using non-ionic surfactant vesicles as carriers for the sustained delivery of water soluble anti-cancer drug Capecitabine, used in the treatment of colorectal cancer. The niosomal formulations were prepared using various non-ionic surfactants (span 40, span 60, tween 40 and tween 60 in the presence of cholesterol, by thin film hydration technique. The effect of process related variables like hydration time, sonication time, rotation speed of evaporation flask on the entrapment efficiency and in vitro drug release were evaluated. Formulation of Capecitabine niosomes was optimized by altering the proportions of Tween, Span and cholesterol. The formation, morphology and size of the drug loaded niosomes were determined by optical microscopy, transmission electron microscopy and particle size analyzer respectively. Results showed a substantial change in the release rate and in the % Entrapment of Capecitabine from niosomal formulations upon varying the type of surfactant and cholesterol content. In-vitro drug release results confirmed that the niosomal formulations have exhibited a higher retention of Capecitabine inside the vesicles such that the in-vitro release was slower compared to the drug solution. Highest drug entrapment (59.1±0.72% and sustained release (67.95±0.65% was obtained with vesicles formed using tween 60 and cholesterol in 4:1 ratio. The optimized niosomal formulation was subjected to stability studies at 4±2°C and 27±2°C for a period of three months.

  13. {sup 188}Re-HEDP combined with capecitabine in hormone-refractory prostate cancer patients with bone metastases: a phase I safety and toxicity study

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Marnix G.E.H. [University Medical Center Utrecht, Department of Nuclear Medicine, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, P.O. Box 85500, Utrecht (Netherlands); Bosma, Tjitske B.; Rijk, Peter P. van [University Medical Center Utrecht, Department of Nuclear Medicine, Utrecht (Netherlands); Zonnenberg, Bernard A. [UMC Utrecht, Department of Internal Medicine, Utrecht (Netherlands)

    2009-09-15

    {sup 188}Re-HEDP is indicated for the treatment of pain in patients with painful osteoblastic bone metastases, including hormone-refractory prostate cancer patients. Efficacy may be improved by adding chemotherapy to the treatment regimen as a radiation sensitizer. The combination of {sup 188}Re-HEDP and capecitabine (Xeloda registered) was tested in a clinical phase I study. Patients with hormone-refractory prostate cancer were treated with capecitabine for 14 days (oral twice daily in a dose escalation regimen with steps of 1/3 of 2,500 mg/m{sup 2} per day in cohorts of three to six patients, depending on toxicity). Two days later patients were treated with 37 MBq/kg {sup 188}Re-HEDP as an intravenous injection. Six hours after treatment post-therapy scintigraphy was performed. Urine was collected for 8 h post-injection. Follow-up was at least 8 weeks. The primary end-point was to establish the maximum tolerable dose (MTD) of capecitabine when combined with {sup 188}Re-HEDP. Secondary end-points included the effect of capecitabine on the biodistribution and pharmacokinetics of {sup 188}Re-HEDP. Three patients were treated in the first and second cohorts, each without unacceptable toxicity. One of six patients in the highest cohort experienced unacceptable toxicity (grade 4 thrombopaenia). The MTD proved to be the maximum dose of 2,500 mg/m{sup 2} per day capecitabine. No unexpected toxicity occurred. Capecitabine had no effect on uptake or excretion of {sup 188}Re-HEDP. Capecitabine may be safely used in combination with {sup 188}Re-HEDP in a dose of 2,500 mg/m{sup 2} per day and 37 MBq/kg, respectively. Efficacy will be further studied in a phase II study using these dosages. (orig.)

  14. Concomitant lung metastasis in patients with advanced hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Tian Yang; Jun-Hua Lu; Chuan Lin; Song Shi; Ting-Hao Chen; Rong-Hua Zhao; Yi Wang; Meng-Chao Wu

    2012-01-01

    AIM:To investigate the clinical features and prognostic factors of advanced hepatocellular carcinoma (HCC) patients presenting with lung metastasis at initial diagnosis.METHODS:Between 2001 and 2010,we recruited 76consecutive HCC patients initially presenting with lung metastasis,without co-existing metastasis from other sites.These patients were divided into three groups:untreated group (n =22),single treatment group (n =19),and combined treatment group (n =35).RESULTS:Metastasis of bilateral lung lobes was common and noted in 35 patients (46.1%),and most of patients (59/76,77.6%) presented with multiple lung metastatic nodules.Nineteen patients (25.0%)received single-method treatment,including hepatectomy in 4,transcatheter arterial chemoembolization in 6,radiotherapy in 5,and oral sorafenib in 4.Thirty-five patients (46.1%) received combined treatment modalities.The overall median survival of the all patients was 8.7 ± 0.6 mo; 4.1 ± 0.3,6.3 ± 2.5 and 18.6 ± 3.9 mo,respectively in the untreated group,single treatment group and combined treatment group,respectively,with a significant difference (log-rank test,P < 0.001).Multivariate analysis revealed that Child-Pugh score,the absence or presence of portal vein tumor thrombus,and treatment modality were three independent prognostic factors affecting survival of patients with advanced HCC and concomitant lung metastasis.CONCLUSION:Combined treatment modalities tend to result in a better survival as compared with the conservative treatment or single treatment modality for HCC patients initially presenting with lung metastasis.

  15. Concomitant Chemoradiotherapy as a Standard Treatment for Squamous Cell Carcinoma of the Temporal Bone

    OpenAIRE

    Shiga, Kiyoto; Ogawa, Takenori; Maki, Atsuko; Amano, Masanori; Kobayashi, Toshimitsu

    2011-01-01

    We sought to characterize the effectiveness of concomitant chemoradiotherapy (CCRT) for patients with squamous cell carcinoma of the temporal bone. We performed a retrospective chart review of 14 patients with cancer of the temporal bone who were provided initial treatment in our hospital from December 2001 to November 2008. Four patients with stage I tumors were treated by radiation therapy alone or with oral administration of S1. One patient with a stage II tumor was treated by radiation th...

  16. Concomitant Urothelial Cancer and Renal Tuberculosis

    OpenAIRE

    Chin, Sheray N.; Tanya Foster; Gurendra Char; Audene Garrison

    2014-01-01

    We report a case of coexisting urothelial cancer and renal tuberculosis in the same kidney. The patient is a 72-year-old female with a remote history of treated pulmonary tuberculosis who presented with haematuria, initial investigation of which elucidated no definitive cause. Almost 1 year later, a diagnosis of metastatic urinary tract cancer was made. The patient received chemotherapy for advanced collecting duct type renal cell carcinoma, based on histological features of renal biopsy. Sub...

  17. Subgroup Analyses from a Phase 3, Open-Label, Randomized Study of Eribulin Mesylate Versus Capecitabine in Pretreated Patients with Advanced or Metastatic Breast Cancer

    Science.gov (United States)

    Twelves, Chris; Awada, Ahmad; Cortes, Javier; Yelle, Louise; Velikova, Galina; Olivo, Martin S.; Song, James; Dutcus, Corina E.; Kaufman, Peter A.

    2016-01-01

    PURPOSE AND METHODS Our secondary analyses compared survival with eribulin versus capecitabine in various patient subgroups from a phase 3, open-label, randomized study. Eligible women aged ≥18 years with advanced/metastatic breast cancer and ≤3 prior chemotherapies (≤2 for advanced/metastatic disease), including an anthracycline and taxane, were randomized 1:1 to intravenous eribulin mesylate 1.4 mg/m2 on days 1 and 8 or twice-daily oral capecitabine 1250 mg/m2 on days 1–14 (21-day cycles). RESULTS In the intent-to-treat population (eribulin 554 and capecitabine 548), overall survival appeared longer with eribulin than capecitabine in various subgroups, including patients with human epidermal growth factor receptor 2-negative (15.9 versus 13.5 months, respectively), estrogen receptor-negative (14.4 versus 10.5 months, respectively), and triple-negative (14.4 versus 9.4 months, respectively) disease. Progression-free survival was similar between the treatment arms. CONCLUSIONS Patients with advanced/metastatic breast cancer and human epidermal growth factor receptor 2-, estrogen receptor-, or triple-negative disease may gain particular benefit from eribulin as first-, second-, and third-line chemotherapies. TRIAL REGISTRATION (PRIMARY STUDY) This study reports the subgroup analyses of eribulin versus capecitabine from a phase 3, open-label, randomized study (www.clinicaltrials.gov; ClinicalTrials.gov identifier: NCT00337103). PMID:27398025

  18. Emerging new therapeutic applications of capecitabine as a first-line chemotherapeutic agent in the management of advanced carcinomas other than colorectal carcinoma

    Directory of Open Access Journals (Sweden)

    Kapoor S

    2012-05-01

    Full Text Available Shailendra KapoorRichmond, VA, USAI read with great interest the recent article by Hameed et al in a recent issue of your journal.1 The article is very interesting. Interestingly, the past few years have seen the emergence of capecitabine as a highly potent first-line chemotherapeutic agent against advanced systemic carcinomas other than colorectal carcinoma. For instance, capecitabine has recently been used successfully as a first-line monotherapeutic agent for HER-2-negative metastatic breast cancer.2 Cotherapy with agents such as sorafenib and paclitaxel for HER-2-negative metastatic breast cancer has also been recently used first-line, and significantly improves progressionfree survival, in addition to being very safe.3,4 Similarly, in patients with advanced gastric carcinoma, capecitabine has been used successfully as first-line therapy in combination with agents such as cisplatin.5 The XELOX regimen comprising capecitabine in conjunction with oxaliplatin is another recent highly effective alternative for gastric carcinoma.6 The modified XELIRI regimen compromising capecitabine and irinotecan is a further option for advanced and unresectable gastric carcinoma.7View original paper by Hameed and colleagues.

  19. Comparison of the efficacy and safety of S-1-based and capecitabine-based regimens in gastrointestinal cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Xunlei Zhang

    Full Text Available PURPOSE: Oral fluoropyrimidine (S-1, capecitabine has been considered as an important part of various regimens. We aimed to evaluate the efficacy and safety of S-1-based therapy versus capecitabine -based therapy in gastrointestinal cancers. METHODS: Eligible studies were identified from Pubmed, EMBASE. Additionally, abstracts presented at American Society of Clinical Oncology (ASCO conferences held between 2000 and 2013 were searched to identify relevant clinical trials. The outcome included overall survival (OS, progression-free survival (PFS, overall response rate (ORR, disease control rate (DCR and advent events. RESULTS: A total of 6 studies (4 RCTs and 2 retrospective analysis studies containing 790 participants were included in this meta-analysis, including 401 patients in the S-1-based group and 389 patients in the capecitabine-based group. Results of our meta-analysis indicated that S-1-based and capecitabine-based regimens showed very similar efficacy in terms of PFS (HR 0.92, 95% CI 0.78-1.09, P = 0.360, OS (HR 1.01, 95% CI 0.84-1.21, P = 0.949, ORR (HR 1.04, 95% CI 0.87-1.25, P = 0.683 and DCR (HR 1.02, 95% CI 0.94-1.10, P = 0.639. There was also no significant difference in toxicity between regimens other than mild more hand-foot syndrome in capecitabine-based regimens. CONCLUSION: Both the S-1-based and capecitabine-based regimens are equally active and well tolerated, and have the potential of backbone chemotherapy regimen in further studies of gastrointestinal cancers.

  20. S-1-Based versus capecitabine-based preoperative chemoradiotherapy in the treatment of locally advanced rectal cancer: a matched-pair analysis.

    Directory of Open Access Journals (Sweden)

    Meng Su

    Full Text Available OBJECTIVE: The aim of this paper was to compare the efficacy and safety of S-1-based and capecitabine-based preoperative chemoradiotherapy regimens in patients with locally advanced rectal cancer through a retrospective matched-pair analysis. MATERIALS AND METHODS: Between Jan 2010 and Mar 2014, 24 patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with S-1 were individually matched with 24 contemporary patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with capecitabine according to clinical stage (as determined by pelvic magnetic resonance imaging and computed tomography and age (within five years. All these patients performed mesorectal excision 4-8 weeks after the completion of chemoradiotherapy. RESULTS: The tumor volume reduction rates were 55.9±15.1% in the S-1 group and 53.8±16.0% in the capecitabine group (p = 0.619. The overall downstaging, including both T downstaging and N downstaging, occurred in 83.3% of the S-1 group and 70.8% of the capecitabine group (p = 0.508. The significant tumor regression, including regression grade I and II, occurred in 33.3% of S-1 patients and 25.0% of capecitabine patients (p = 0.754. In the two groups, Grade 4 adverse events were not observed and Grade 3 consisted of only two cases of diarrhea, and no patient suffered hematologic adverse event of Grade 2 or higher. However, the incidence of diarrhea (62.5% vs 33.3%, p = 0.014 and hand-foot syndrome (29.2% vs 0%, p = 0.016 were higher in capecitabine group. Other adverse events did not differ significantly between two groups. CONCLUSIONS: The two preoperative chemoradiotherapy regimens were effective and safe for patients of locally advanced rectal cancer, but regimen with S-1 exhibited a lower incidence of adverse events.

  1. Analysis of potential response predictors to capecitabine/temozolomide in metastatic pancreatic neuroendocrine tumors.

    Science.gov (United States)

    Cives, M; Ghayouri, M; Morse, B; Brelsford, M; Black, M; Rizzo, A; Meeker, A; Strosberg, J

    2016-09-01

    The capecitabine and temozolomide (CAPTEM) regimen is active in the treatment of metastatic pancreatic neuroendocrine tumors (pNETs), with response rates ranging from 30 to 70%. Small retrospective studies suggest that O(6)-methylguanine DNA methyltransferase (MGMT) deficiency predicts response to temozolomide. High tumor proliferative activity is also commonly perceived as a significant predictor of response to cytotoxic chemotherapy. It is unclear whether chromosomal instability (CIN), which correlates with alternative lengthening of telomeres (ALT), is a predictive factor. In this study, we evaluated 143 patients with advanced pNET who underwent treatment with CAPTEM for radiographic and biochemical response. MGMT expression (n=52), grade (n=128) and ALT activation (n=46) were investigated as potential predictive biomarkers. Treatment with CAPTEM was associated with an overall response rate (ORR) of 54% by RECIST 1.1. Response to CAPTEM was not influenced by MGMT expression, proliferative activity or ALT pathway activation. Based on these results, no biomarker-driven selection criteria for use of the CAPTEM regimen can be recommended at this time. PMID:27552969

  2. Phase I study of capecitabine combined with radioembolization using yttrium-90 resin microspheres (SIR-Spheres) in patients with advanced cancer

    OpenAIRE

    Cohen, S J; Konski, A A; Putnam, S; Ball, D S; Meyer, J E; J. Q. Yu; Astsaturov, I; Marlow, C; Dickens, A; Cade, D N; Meropol, N J

    2014-01-01

    Background: This was a prospective single-centre, phase I study to document the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and the recommended phase II dose for future study of capecitabine in combination with radioembolization. Methods: Patients with advanced unresectable liver-dominant cancer were enrolled in a 3+3 design with escalating doses of capecitabine (375–1000 mg/m2 b.i.d.) for 14 days every 21 days. Radioembolization with 90Y-resin microspheres was administered us...

  3. 188Re-HEDP combined with capecitabine in hormone-refractory prostate cancer patients with bone metastases: a phase I safety and toxicity study

    OpenAIRE

    Lam, Marnix G.E.H.; Bosma, Tjitske B.; Rijk, Peter P. van; Zonnenberg, Bernard A.

    2009-01-01

    Purpose 188Re-HEDP is indicated for the treatment of pain in patients with painful osteoblastic bone metastases, including hormone-refractory prostate cancer patients. Efficacy may be improved by adding chemotherapy to the treatment regimen as a radiation sensitizer. The combination of 188Re-HEDP and capecitabine (Xeloda®) was tested in a clinical phase I study. Methods Patients with hormone-refractory prostate cancer were treated with capecitabine for 14 days (oral twice daily in a dose esca...

  4. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin.

    Directory of Open Access Journals (Sweden)

    Yulia Kundel

    Full Text Available Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m(2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial at 12 weeks was 86%. Side effects were of mild intensity (grade I or II and included nausea (38% of patients, weakness (24%, diarrhea (24%, mucositis (10%, and hand and foot syndrome (7%.External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.ClinicalTrials.gov NCT01784393NCT01784393.

  5. Pilot study of postoperative adjuvant chemoradiation for advanced gastric cancer: Adjuvant 5-FU/cisplatin and chemoradiation with capecitabine

    Institute of Scientific and Technical Information of China (English)

    Hyung-Sik Lee; Min-Chan Kim; Youngmin Choi; Won-Joo Hur; Hyo-Jin Kim; Hyuk-Chan Kwon; Sung-Hyun Kim; Jae-Seok Kim; Jong-Hoon Lee; Ghap-Joong Jung

    2006-01-01

    AIM: To evaluate the efficacy and toxicity of postoperative chemoradiation using FP chemotherapy and oral capecitabine during radiation for advanced gastric cancer following curative resection.METHODS: Thirty-one patients who had underwent a potentially curative resection for Stage Ⅲ and Ⅳ (MO) gastric cancer were enrolled. Therapy consists of one cycle of FP (continuous infusion of 5-FU 1000 mg/m2 on d 1 to 5 and cisplatin 60 mg/m2 on d 1) followed by 4500 cGy (180 cGy/d) with capecitabine (1650 mg/m2 daily throughout radiotherapy). Four wk after completion of the radiotherapy, patients received three additional cycles of FP every three wk. The median follow-up duration was 22.2 mo.RESULTS: The 3-year disease free and overall survival in this study were 82.7% and 83.4%, respectively. Four patients (12.9%) showed relapse during follow-up. Eight patients did not complete all planned adjuvant therapy.Grade 3/4 toxicities included neutropenia in 50.2%, anemia in 12.9%, thrombocytopenia in 3.2% and nausea/vomiting in 3.2%. Neither grade 3/4 hand foot syndrome nor treatment related febrile neutropenia or death were observed.CONCLUSION: These preliminary results suggest that this postoperative adjuvant chemoradiation regimen of FP before and after capecitabine and concurrent radiotherapy appears well tolerated and offers a comparable toxicity profile to the chemoradiation regimen utilized in INT-0116. This treatment modality allowed successful loco-regional control rate and 3-year overall survival.

  6. Phase II study of radiopeptide {sup 177}Lu-octreotate and capecitabine therapy of progressive disseminated neuroendocrine tumours

    Energy Technology Data Exchange (ETDEWEB)

    Claringbold, Phillip G. [Fremantle Hospital, Department of Oncology, Fremantle, WA (Australia); Brayshaw, Paul A.; Turner, J.H. [University of Western Australia, Department of Nuclear Medicine, Fremantle Hospital, Fremantle, WA (Australia); Price, Richard A. [Fremantle Hospital, Department of Radiology, Fremantle, WA (Australia)

    2011-02-15

    In this phase II study we investigated the safety and efficacy of combination capecitabine and {sup 177}Lu-octreotate for the treatment of disseminated, progressive, unresectable neuroendocrine tumours (NETs). Enrolled in the study were 33 patients with biopsy-proven NETs, positive {sup 111}In-octreotide scintigraphy and progressive disease measurable by CT/MRI who were to receive four cycles of 7.8 GBq {sup 177}Lu-octreotate 8-weekly, with 14 days of 1,650 mg/m{sup 2} capecitabine per day. Of the 33 patients, 25 completed four cycles. Minimal transient myelosuppression at 3-4 weeks caused grade 3 thrombocytopenia in one patient but no neutropenia. Nephrotoxicity was absent. Critical organ radiation dosimetry provided median estimates of the dose per cycle to the kidneys of 2.4 Gy and to the liver of 4.8 Gy, and showed cumulative doses all below toxic thresholds. Objective response rates (ORR) were 24% partial response (PR), 70% stable disease (SD) and 6% progressive disease. Median progression-free survival and median overall survival had not been reached at a median follow-up of 16 months (range 5-33 months). Survival at 1 and 2 years was 91% (95% CI 75-98%) and 88% (95% CI 71-96%), respectively. The addition of capecitabine radiosensitizing chemotherapy does not increase the minimal toxicity of {sup 177}Lu-octreotate radiopeptide therapy and led to an ORR of 24% PR and 70% minor response or SD in patients with progressive metastatic NETs. Tumour control and stabilization of disease was obtained in 94% of these patients. (orig.)

  7. Clinical applications of continuous infusion chemotherapy ahd concomitant radiation therapy

    International Nuclear Information System (INIS)

    This book presents information on the following topics: theoretical basis and clinical applications of 5-FU as a radiosensitizer; treatment of hepatic metastases from gastro intestingal primaries with split course radiation therapy; combined modality therapy with 5-FU, Mitomycin-C and radiation therapy for sqamous cell cancers; treatment of bladder carcinoma with concomitant infusion chemotherapy and irradiation; a treatment of invasiv bladder cancer by the XRT/5FU protocol; concomitant radiation therapy and doxorubicin by continuous infusion in advanced malignancies; cis platin by continuous infusion with concurrent radiation therapy in malignant tumors; combination of radiation with concomitant continuous adriamycin infusion in a patient with partially excised pleomorphic soft tissue sarcoma of the lower extremeity; treatment of recurrent carcinoma of the paranasal sinuses using concomitant infusion cis-platinum and radiation therapy; hepatic artery infusion for hepatic metastases in combination with hepatic resection and hepatic radiation; study of simultaneous radiation therapy, continuous infusion, 5FU and bolus mitomycin-C; cancer of the esophagus; continuous infusion VP-16, bolus cis-platinum and simultaneous radiation therapy as salvage therapy in small cell bronchogenic carcinoma; and concomitant radiation, mitomycin-C and 5-FU infusion in gastro intestinal cancer

  8. Neoadjuvant capecitabine, radiotherapy, and bevacizumab (CRAB in locally advanced rectal cancer: results of an open-label phase II study

    Directory of Open Access Journals (Sweden)

    Edhemovic Ibrahim

    2011-08-01

    Full Text Available Abstract Background Preoperative capecitabine-based chemoradiation is a standard treatment for locally advanced rectal cancer (LARC. Here, we explored the safety and efficacy of the addition of bevacizumab to capecitabine and concurrent radiotherapy for LARC. Methods Patients with MRI-confirmed stage II/III rectal cancer received bevacizumab 5 mg/kg i.v. 2 weeks prior to neoadjuvant chemoradiotherapy followed by bevacizumab 5 mg/kg on Days 1, 15 and 29, capecitabine 825 mg/m2 twice daily on Days 1-38, and concurrent radiotherapy 50.4 Gy (1.8 Gy/day, 5 days/week for 5 weeks + three 1.8 Gy/day, starting on Day 1. Total mesorectal excision was scheduled 6-8 weeks after completion of chemoradiotherapy. Tumour regression grades (TRG were evaluated on surgical specimens according to Dworak. The primary endpoint was pathological complete response (pCR. Results 61 patients were enrolled (median age 60 years [range 31-80], 64% male. Twelve patients (19.7% had T3N0 tumours, 1 patient T2N1, 19 patients (31.1% T3N1, 2 patients (3.3% T2N2, 22 patients (36.1% T3N2 and 5 patients (8.2% T4N2. Median tumour distance from the anal verge was 6 cm (range 0-11. Grade 3 adverse events included dermatitis (n = 6, 9.8%, proteinuria (n = 4, 6.5% and leucocytopenia (n = 3, 4.9%. Radical resection was achieved in 57 patients (95%, and 42 patients (70% underwent sphincter-preserving surgery. TRG 4 (pCR was recorded in 8 patients (13.3% and TRG 3 in 9 patients (15.0%. T-, N- and overall downstaging rates were 45.2%, 73.8%, and 73.8%, respectively. Conclusions This study demonstrates the feasibility of preoperative chemoradiotherapy with bevacizumab and capecitabine. The observed adverse events of neoadjuvant treatment are comparable with those previously reported, but the pCR rate was lower.

  9. Neoadjuvant capecitabine, radiotherapy, and bevacizumab (CRAB) in locally advanced rectal cancer: results of an open-label phase II study

    International Nuclear Information System (INIS)

    Preoperative capecitabine-based chemoradiation is a standard treatment for locally advanced rectal cancer (LARC). Here, we explored the safety and efficacy of the addition of bevacizumab to capecitabine and concurrent radiotherapy for LARC. Patients with MRI-confirmed stage II/III rectal cancer received bevacizumab 5 mg/kg i.v. 2 weeks prior to neoadjuvant chemoradiotherapy followed by bevacizumab 5 mg/kg on Days 1, 15 and 29, capecitabine 825 mg/m2 twice daily on Days 1-38, and concurrent radiotherapy 50.4 Gy (1.8 Gy/day, 5 days/week for 5 weeks + three 1.8 Gy/day), starting on Day 1. Total mesorectal excision was scheduled 6-8 weeks after completion of chemoradiotherapy. Tumour regression grades (TRG) were evaluated on surgical specimens according to Dworak. The primary endpoint was pathological complete response (pCR). 61 patients were enrolled (median age 60 years [range 31-80], 64% male). Twelve patients (19.7%) had T3N0 tumours, 1 patient T2N1, 19 patients (31.1%) T3N1, 2 patients (3.3%) T2N2, 22 patients (36.1%) T3N2 and 5 patients (8.2%) T4N2. Median tumour distance from the anal verge was 6 cm (range 0-11). Grade 3 adverse events included dermatitis (n = 6, 9.8%), proteinuria (n = 4, 6.5%) and leucocytopenia (n = 3, 4.9%). Radical resection was achieved in 57 patients (95%), and 42 patients (70%) underwent sphincter-preserving surgery. TRG 4 (pCR) was recorded in 8 patients (13.3%) and TRG 3 in 9 patients (15.0%). T-, N- and overall downstaging rates were 45.2%, 73.8%, and 73.8%, respectively. This study demonstrates the feasibility of preoperative chemoradiotherapy with bevacizumab and capecitabine. The observed adverse events of neoadjuvant treatment are comparable with those previously reported, but the pCR rate was lower

  10. Dental trauma. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander; Ahrensburg, Søren Steno; Kreiborg, Sven; Andreasen, Jens Ove

    2012-01-01

    The reported risk of pulp necrosis (PN) is low in teeth with concussion injuries. A concomitant crown fracture may affect the risk of PN. Aim:  To analyze the influence of a crown fracture (with and without pulp exposure) on the risk of PN in teeth with concussion injury. Material:  The study...... included 469 permanent incisors with concussion from 358 patients (226 male, 132 female). Among these, 292 had a concomitant crown fracture (70 with and 222 without pulp exposure). All teeth were examined and treated according to standardized protocol. Statistical analysis:  The risk of PN was analyzed by...... increased to 55.0% (95% CI: 34.3–75.8). Conclusion:  No response to EPT at the initial examination or a concomitant crown fracture significantly increased the risk of PN in teeth with concussion injury and mature root development. If both risk factors were present there was a synergetic effect....

  11. FORMULATION AND CHARECTERISATION OF COLON TARGETED PH DEPENDENT MICROSPHERES OF CAPECITABINE FOR COLORECTAL CANCER

    Directory of Open Access Journals (Sweden)

    Dilip Agarwal

    2013-11-01

    Full Text Available The aim of the present work was to prepare the colon-targeting microspheres of capecitabine (CPB for the treatment of colorectal cancer to reduce dosing frequency and improve patient compliance. PH-sensitive polymer Eudragit L100, S100 separately and in combination (1:2 was used to formulate the microspheres by emulsion solvent diffusion technique using varying drug – polymer ratios (1:2 to 1:6. Microspheres were evaluated for particle size, shape, flow properties, surface morphology by scanning electron microscopy, yield, drug content, and in vitro drug release behavior and found to be significantly affected by polymer concentration. The formulated microspheres were discrete, spherical with relatively smooth surface, and with good flow properties. CPB-loaded microspheres demonstrated good entrapment efficiency (53.28 to 93.76%. The release study was done in simulated gastrointestinal fluids for 2 hrs in SGF (pH 1.2, for 3 hrs in SIF (pH 6.8 and up to 24 hrs in SCF (pH 7.4 and have shown that the drug was protected from being released in the physiological environment of the stomach and small intestine and efficiently released in colon (99.39%. Formulation ELS2 gave the best result among all formulations (1.59% release at end of 2 hrs, 19.24% at the end of 5 hr, and 99.39% at the end of the study. It is concluded from the present study that pH sensitive Eudragit microspheres are promising carriers for oral colon-targeted delivery of CPB for colorectal cancer.

  12. Concurrent chemoradiation of metastases with capecitabine and oxaliplatin and 3D-CRT in patients with oligometastatic colorectal cancer: results of a phase I study

    International Nuclear Information System (INIS)

    Local control appears to be an important treatment aim in patients with limited metastases (oligometastases) of colorectal cancer (CRC). Those patients show a favourable prognosis, if - in addition to the local effective treatment - an occurrence of new metastases may also be postponed by effective systemic therapy. The purpose of this dose escalation phase I study was to establish the efficacy of local radiotherapy (RT) of oligometastatic CRC with a concurrent standard chemotherapy regimen. Patients with first-, second- or third-line therapy of oligometastatic CRC (1–3 metastases or local recurrence plus max. 2 metastases) received capecitabine (825 mg/m2/d BID d 1–14; 22–35) and oxaliplatin (50 mg/m2 d 1, 8, 22, 29). 3D-conformal RT of all metastatic lesions was delivered in 2.0 Gy up to 36 Gy to 50 Gy (3 dose levels). Primary endpoint was the maximal tolerable dose (MTD) of RT defined as the level at which two or more of six patients experienced dose-limiting toxicity (DLT). Between 09/2004 and 08/2007, 9 patients (7 male, 2 female, 50–74 years) were enrolled, 6 patients treated at dose level 1 (36 Gy), 3 patients at dose level 2 (44 Gy). 1 patient from the first cohort experienced DLT (oxaliplatin-related hypersensitivity reaction). No radiation-induced DLT occurred. 6/9 patients achieved objective response (partial remission). One year after initiation, all patients were alive, 6 patients survived (16 to 54 months) patients died of tumor progression (14 to 23 months). The phase II part of the trial had to be closed due to recruitment failure. Local 3D-CRT to metastatic lesions in addition to standard chemotherapy was feasible, DLT was not documented. 3/9 patients survived for a period of 3.5 to 4.4 years (time at the last evaluation). Radiotherapy of metastatic lesions should be incorporated into subsequent trials

  13. 19F MRSI of capecitabine in the liver at 7T using broadband transmit-receive antennas and dual-band RF pulses

    NARCIS (Netherlands)

    van Gorp, Sjoerd; Seevinck, Peter R.; Andreychenko, Anna; Raaijmakers, AJE; Luijten, Peter R.; Viergever, Max A.; Koopman, Miriam; Boer, Vincent O.; Klomp, Dennis W J

    2015-01-01

    Capecitabine (Cap) is an often prescribed chemotherapeutic agent, successfully used to cure some patients from cancer or reduce tumor burden for palliative care. However, the efficacy of the drug is limited, it is not known in advance who will respond to the drug and it can come with severe toxicity

  14. Adjuvant treatment of breast cancer by concomitant hormonotherapy and radiotherapy: state of the art

    International Nuclear Information System (INIS)

    Combining radiation and hormone therapy has become common clinical practice in recent years for locally advanced prostate cancer. The use of such concomitant therapy in the treatment of breast disease has been very infrequently reported in the literature, but such an application seems justified given the common hormonal dependence of breast cancer and the potential synergetic effect of these two treatment modalities. As adjuvant therapy, tamoxifen is the key drug in the hormonal treatment arsenal, providing a significant improvement in both local control and global survival rates. Aromatase inhibitors are currently being evaluated in this setting, and initial results are promising. In vitro, tamoxifen does not seem to offer a protective effect against radiation. In clinical use, the few available published studies confirm the superiority of the association of radiation with tamoxifen as opposed to radiation therapy alone in decreasing local recurrences of surgically removed breast tumors. Toxicity associated with such concomitant therapy includes mainly subcutaneous and pulmonary fibrosis. However, subcutaneous fibrosis and its cosmetic impact on the treated breast are frequently described side effects of radiation therapy, and their incidence may actually be reduced when tamoxifen is associated. The evidence is less controversial for pulmonary fibrosis, which is more common with the concomitant therapy. The association of radiation and aromatase inhibitors has as of yet rarely been reported. Letrozole (Femara) has a radiosensitizing effect on breast-cancer cell lines transfected with the aromatase gene. Clinical data assessing this effect in vivo are not available. The FEMTABIG study (letrozole vs. tamoxifen vs. sequential treatment) did not specify the sequence of radiation and hormonal therapy. The ATAC study comparing the adjuvant use of anastrozole (Arimidex )and tamoxifen does not provide any information on the number of patients receiving radiation

  15. Phase I study of neoadjuvant accelerated short course radiation therapy with photons and capecitabine for resectable pancreatic cancer

    International Nuclear Information System (INIS)

    Purpose: In this phase I study, we sought to determine the feasibility and tolerability of neoadjuvant short course radiotherapy (SC-CRT) delivered with photon RT with concurrent capecitabine for resectable pancreatic adenocarcinoma. Materials and methods: Ten patients with localized, resectable pancreatic adenocarcinoma were enrolled from December 2009 to August 2011. In dose level I, patients received 3 Gy × 10. In dose level 2, patients received 5 Gy × 5 (every other day). In dose level 3, patients received 5 Gy × 5 (consecutive days). Capecitabine was given during weeks 1 and 2. Surgery was performed 1–3 weeks after completion of chemotherapy. Results: With an intended accrual of 12 patients, the study was closed early due to unexpected intraoperative complications. Compared to the companion phase I proton study, patients treated with photons had increased intraoperative RT fibrosis reported by surgeons (27% vs. 63%). Among those undergoing a Whipple resection, increased RT fibrosis translated to an increased mean OR time of 69 min. Dosimetric comparison revealed significantly increased low dose exposure to organs at risk for patients treated with photon RT. Conclusions: This phase I experience evaluating the tolerability of neoadjuvant SC-CRT with photon RT closed early due to unexpected intraoperative complications

  16. Reports and document analysis on hypokalemia caused by capecitabine%卡培他滨导致低钾血症的临床分析

    Institute of Scientific and Technical Information of China (English)

    宋芳华; 单丹妮; 姜雪滨; 尹晓芹

    2014-01-01

    Objective To discuss the occurrence the reasons and the treatment of the hypokalemia caused by capecitabine.Methods The clinical data of 126 patients with colorectal cancer,stomach cancer and breast cancer in Xin-Hua hospital affliated to Dalian university treated only by Capecitabine (doses and appilication:1 000-1 250 mg/m2 every time,twice a day,continuing to the fourteenth day,and stopping in 7 days)were retrospectively analyzed,and all patients took Capecitabine more than 3 cycles and less than 10 cycles,then we discovered the patients with hypokalemia,and the occurrence,the reasons and the treatment of the hypokalemia caused by capecitabine were summarized and analyzed.Results The occurrence of the hypokalemia caused by capecitabine was 14.3% (18/126),and the occurrence of hypokalemia indirectly by capecitabine was 77.8% (14/18),and the occurrence of hypokalemia directly by capecitabine was 22.2% (4/18).The serum potassium returned to normality after treatment that potassium was supplemented by oral or intravenous drip,and no patients quited because of hypokalemia.Conclusions Capecitabine can directly lead to hypokalemia and capecitabine can also directly lead to hypokalemia.Doctors should make a point of the hypokalemia caused by capecitabine.%目的 探讨卡培他滨导致低钾血症的发生率、原因及治疗.方法 回顾性分析大连大学附属新华医院126例接受卡培他滨单药治疗(剂量及用法:每次1 000 ~1 250 mg/m2,每日2次,口服14 d,停用7d,21 d为1周期)的结直肠癌、胃癌、乳腺癌患者的临床资料,患者用药均超过3个周期,不超过10个周期,查找出其中出现低钾血症的患者,总结分析低钾血症的发生率、原因及治疗方法.结果 126例患者中,低钾血症发生率为14.3%(18/126),其中卡培他滨间接导致的低钾血症占77.8%(14/18),卡培他滨直接导致低钾血症占22.2%(4/18).经过及时的口服或静脉补钾治疗,患者的

  17. Concomitant boost radiotherapy for muscle invasive bladder cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate the feasibility and efficacy of a concomitant partial bladder boost schedule in radiotherapy for invasive bladder cancer, coupling a limited boost volume with shortening of the overall treatment time. Methods and materials: Between 1994 and 1999, 50 patients with a T2-T4 N0M0 transitional cell carcinoma of the bladder received radiotherapy delivered in a short overall treatment time with a concomitant boost technique. With this technique a dose of 40 Gy in 2-Gy fractions was administered to the small pelvis with a concomitant boost limited to the bladder tumor area plus margin of 15 Gy in fractions of 0.75 Gy. The total tumor dose was 55 Gy in 20 fractions in 4 weeks. Toxicity was scored according to EORTC/RTOG toxicity criteria. Results: The feasibility of the treatment was good. Severe acute toxicity ≥G3 was observed in seven patients (14%). Severe late toxicity ≥G3 was observed in six patients (13%). Thirty-seven patients (74%) showed a complete and five (10 %) a partial remission after treatment. The actuarial 3-year freedom of local progression was 55%. Conclusion: In external radiotherapy for muscle invasive bladder cancer a concomitant boost technique coupling a partial bladder boost with shortening of the overall treatment time provides a high probability of local control with acceptable toxicity

  18. Concomitant Presentation of Alopecia Areata in Siblings: A Rare Occurrence

    OpenAIRE

    Menon, Roshni; Kiran, CM

    2012-01-01

    Alopecia areata (AA) is one among the many causes of non-scarring alopecia in children. Family history has been noted in 10-20% of cases, but concomitant presentation in siblings is extremely rare. The patterns and associations of childhood AA are similar to adults; however, there are some differences which are being highlighted in this article.

  19. Final results of a phase I/II pilot study of capecitabine with or without vinorelbine after sequential dose-dense epirubicin and paclitaxel in high-risk early breast cancer

    Directory of Open Access Journals (Sweden)

    Müller Volkmar

    2010-08-01

    Full Text Available Abstract Background The integration of the non-cross-resistant chemotherapeutic agents capecitabine and vinorelbine into an intensified dose-dense sequential anthracycline- and taxane-containing regimen in high-risk early breast cancer (EBC could improve efficacy, but this combination was not examined in this context so far. Methods Patients with stage II/IIIA EBC (four or more positive lymph nodes received post-operative intensified dose-dense sequential epirubicin (150 mg/m² every 2 weeks and paclitaxel (225 mg/m² every 2 weeks with filgrastim and darbepoetin alfa, followed by capecitabine alone (dose levels 1 and 3 or with vinorelbine (dose levels 2 and 4. Capecitabine was given on days 1-14 every 21 days at 1000 or 1250 mg/m2 twice daily (dose levels 1/2 and 3/4, respectively. Vinorelbine 25 mg/m2 was given on days 1 and 8 of each 21-day course (dose levels 2 and 4. Results Fifty-one patients were treated. There was one dose-limiting toxicity (DLT at dose level 1. At dose level 2 (capecitabine and vinorelbine, five of 10 patients experienced DLTs. Therefore evaluation of vinorelbine was abandoned and dose level 3 (capecitabine monotherapy was expanded. Hand-foot syndrome and diarrhoea were dose limiting with capecitabine 1250 mg/m2 twice daily. At 35.2 months' median follow-up, the estimated 3-year relapse-free and overall survival rates were 82% and 91%, respectively. Conclusions Administration of capecitabine monotherapy after sequential dose-dense epirubicin and paclitaxel is feasible in node-positive EBC, while the combination of capecitabine and vinorelbine as used here caused more DLTs. Trial registration Current Controlled Trials ISRCTN38983527.

  20. The effects of gemcitabine and capecitabine combination chemotherapy and of low-dose adjuvant GM-CSF on the levels of myeloid-derived suppressor cells in patients with advanced pancreatic cancer.

    OpenAIRE

    Annels, NE; Shaw, VE; Gabitass, RF; Billingham, L.; Corrie, P; Eatock, M; Valle, J.; Smith, D; Wadsley, J.; Cunningham, D; Pandha, H; Neoptolemos, JP; Middleton, G.

    2013-01-01

    In pre-clinical models, the only two chemotherapy drugs which have been demonstrated to directly reduce the number of myeloid-derived suppressor cells (MDSCs) are gemcitabine and 5-fluorouracil. Here we analyze the dynamics of MDSCs, phenotyped as Lin-DR-CD11b+, in patients with advanced pancreatic cancer receiving the combination of gemcitabine and capecitabine, a 5-FU pro-drug. We found no evidence that gemcitabine and capecitabine directly reduce MDSC% in patients. Gemcitabine and capecita...

  1. Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme

    Science.gov (United States)

    McGirt, Matthew J.; Than, Khoi D.; Weingart, Jon D.; Chaichana, Kaisorn L.; Attenello, Frank J.; Olivi, Alessandro; Laterra, John; Kleinberg, Lawrence R.; Grossman, Stuart A.; Brem, Henry; Quiñones-Hinojosa, Alfredo

    2016-01-01

    Object Gliadel (BCNU) wafer and concomitant temozolomide (TMZ) therapy, when used individually as adjuvant therapies, extend survival from that achieved by resection and radiation therapy (XRT) for glioblastoma multiforme (GBM). It remains unstudied whether combining Gliadel and TMZ therapy is safe or further improves survival in patients with newly diagnosed GBM. The authors reviewed their initial experience utilizing combined Gliadel, TMZ, and radiation therapy for the treatment of GBM. Methods All cases involving patients undergoing primary resection of GBM with or without Gliadel wafer (3.85% BCNU) implantation and adjuvant XRT over a 10-year period (1997–2006) were retrospectively reviewed. Beginning in 2004, concomitant TMZ became the standard of care at the authors’ institution and all patients with Gliadel implantation also received concomitant TMZ (Stupp protocol). Overall survival and treatment-related morbidity were assessed for all patients treated with Gliadel plus concomitant TMZ (XRT + Gliadel + TMZ). Age-matched (≤ 70 years) comparison of survival and morbidity was performed between the XRT + Gliadel + TMZ (post-2003) and XRT + Gliadel (pre-2004) cohorts. Results Thirty-three patients were treated with XRT + Gliadel + TMZ. The median survival in this group was 20.7 months, with a 2-year survival rate of 36%. Six-month morbidity included surgical site infection in 1 case (3%), perioperative seizures in 2 cases (6%), deep-vein thrombus in 1 (3%), pulmonary embolism in 3 (9%), and cerebral edema requiring admission for intravenous dexamethasone in 1 case (3%). Myelosuppression required premature termination of TMZ in 7 patients (21%) (thrombocytopenia in 5, neutropenia in 2 cases). In patients ≤ 70 years of age, XRT + Gliadel + TMZ (30 patients, post-2003) was independently associated with improved median survival (21.3 vs 12.4 months, p = 0.005) versus XRT + Gliadel (78 patients, pre-2004), with 2-year survival of 39 versus 18%, respectively

  2. The effect of oxaliplatin plus capecitabine in combination with radiation for locally advanced lower or middle sited rectal carcinoma

    International Nuclear Information System (INIS)

    Objective: To explore the effectiveness, toxicity and treatment failure patterns for patients with locally advanced rectal adenocarcinoma after pre-operative radiation and concurrent oxaliplatin plus capecitabine. Methods: Patients with histopathologically proven rectal adenocarcinoma and clinical stage Ⅱ/Ⅲ were enrolled in a prospective phase Ⅱ clinical trial at 2006-2012 years. One hundred and eighty-six patients received pre-operative chemoradiation, which consisted of 44.0-50.4 Gy in 22-28 fractions with concurrent chemotherapy of oral capecitabine 1650 mg/(m2 · d) in bid from d1-35 and oxaliplatin 50 mg/m2 per week for 5 times. Radical surgery was performed 4-8 weeks after chemoradiotherapy. Survival rates and multivariate prognostic factors were estimated by Kaplan-Meier method, comparisons were completed by the Log-rank test. Results: One hundred and thirty-seven patients with clinical stage Ⅱ (n=34) and Ⅲ disease (n=103) underwent radical resection. The lower (the anal distance ≤5 cm) and middle (the anal distance 5-10 cm) located lesions were 102 (74.5%) and 35 (25.5%), respectively. Diarrhea was the most frequent acute Grade 3 toxicity (n=29, 21.2%). Sixty-nine patients (50.4%) were downstaged, and 21 patients (15.3%) achieved complete regression of primary lesion, 20 patients were pathological complete response (yp T0N0). With a median follow-up of 22.2 months, the 2-year overall survival, locoregional recurrence free survival and disease free survival for all patients were 92.4%, 93.1% and 71.0%, respectively. In multivariate analysis, pathological stage of yp 0-Ⅱ was identified as independent factor related to OS and DFS. Conclusions: When delivering oxaliplatin plus capecitabine in combination with radiation for locally advanced lower or middle rectal carcinoma, the 2-year local control was excellent, pathological stage of yp 0-Ⅱ was correlated to the favorable survival. (authors)

  3. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures

    OpenAIRE

    Jain, Anuj; Aggarwal, Prakash; Pankaj, Amite

    2014-01-01

    Objective: The aim of this study was to report our experience on concomitant ipsilateral proximal tibia and femoral Hoffa fractures.Methods: Nine patients (8 male, 1 female; mean age: 30.9; range: 19-49 years) presented to our emergency room with an ipsilateral proximal tibia and femoral Hoffa fracture, following road traffic accident. Six patients had open fracture. Two patients had ipsilateral femoral shaft fracture, two patients had fracture of intercondylar part of distal femur, one had f...

  4. Liver transplant recipient with concomitant cutaneous and visceral leishmaniasis.

    Science.gov (United States)

    Ozcan, Deren; Seçkin, Deniz; Allahverdiyev, Adil M; Weina, Peter J; Aydin, Hakan; Ozçay, Figen; Haberal, Mehmet

    2007-03-01

    Diagnosis of leishmaniasis in immunosuppressed patients may be a serious challenge for physicians because of the major clinical and laboratory differences with immunocompetent patients. In immunosuppressed patients, the disease is characterized usually by disseminated visceral involvement, atypical cutaneous lesions and persistent negativity of diagnostic tests. Here, we report an eight-yr-old liver transplant recipient with concomitant cutaneous and visceral leishmaniasis in whom the cutaneous lesion led to the diagnosis of systemic involvement. PMID:17300508

  5. Concomitant ligamentous and meniscal injuries in floating knee

    OpenAIRE

    Liu, Ya; Jun ZHANG; Zhang, Shu; Li, Rui; Yue, Xianhu

    2015-01-01

    Background: To identify and characterize the concomitant ligamentous and meniscal injuries in floating knee. Methods: A total of 37 cases of floating knee were enrolled. Arthroscopic or open surgical examination of the knee, Lachman test, posterior drawer’s test, and varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. Results: Through arthroscopic and open surgical examinations, a medial meniscal tear was detected in 14 (37.8%) cases and ...

  6. Scandium(3) purification from concomitant impurities by chromatographic methods

    International Nuclear Information System (INIS)

    The process of scandium(3) purification from concomitant impurities (rare earths, Zr(4), Th(4), Fe(3)) using sorptional chromatography has been studied by tracer technique. The relevant sorbents have been chosen and the optimal conditions for scandium isolation have been ascertained. It is shown that employment of sorption-chromatographic methods for scandium purification permits obtaining scandium(3) preparation of 99.99% purity

  7. Clinical Challenges: Myeloma and Concomitant Type 2 Diabetes

    OpenAIRE

    2013-01-01

    Multiple myeloma is a malignant plasma cell disorder that accounts for approximately 10% of all hematologic cancers. It is characterized by accumulation of clonal plasma cells, predominantly in the bone marrow. The prevalence of type 2 diabetes is increasing; therefore, it is expected that there will be an increase in the diagnosis of multiple myeloma with concomitant diabetes mellitus. The treatment of multiple myeloma and diabetes mellitus is multifaceted. The coexistence of the two conditi...

  8. Are clozapine blood dyscrasias associated with concomitant medications?

    Science.gov (United States)

    Demler, Tammie Lee; Trigoboff, Eileen

    2011-04-01

    Clozapine is an atypical antipsychotic agent used for refractory schizophrenia. It has a relatively low affinity for D2 receptors and thus is associated with a lower incidence of extrapyramidal side effects when compared with typical antipsychotics. Clozapine as monotherapy can induce a rare, but serious, blood dyscrasia called agranulocytosis; however, some concomitant medications may contribute to the risk. Examples of these medications are mood-stabilizing antiepileptic drugs, such as carbamazepine, and sulfonamide antibiotics, such as sulfamethoxazole. There were no studies at the writing of this article examining the effect of concomitant medications on clozapine blood dyscrasias, and few published reports describing enhanced bone marrow suppression in those taking clozapine. The primary objective of this study was to evaluate the effect of concomitant medications used in a state psychiatric hospital on clozapine-induced blood dyscrasias. This was a retrospective record review of adverse drug reactions reported at an adult inpatient state psychiatric center. The records for a pilot sample of 26 patients with reported clozapine-related adverse drug reactions between January 1, 2007, and June 30, 2009, were reviewed. Fundamental to this study were reported adverse drug reactions defined as 1) substantial drops in white blood cell or absolute neutrophil count (a substantial drop in white blood cell is >3,000 or absolute neutrophil count is >1,500 over a 3-week period); 2) mild leukopenia/granulocytopenia; and 3) moderate-severe leukopenia/granulocytopenia. Concomitant medications were examined for contributions to an increased potential for clozapine-induced blood dyscrasias. Other data collected included demographic information (age, gender, ethnicity), medical and psychiatric diagnoses, dose and duration of medications, and changes in medications. Medications that had a statistically significant impact on the incidence of clozapine-induced blood dyscrasias are

  9. Are Clozapine Blood Dyscrasias Associated with Concomitant Medications?

    OpenAIRE

    Demler, Tammie Lee; Trigoboff, Eileen

    2011-01-01

    Clozapine is an atypical antipsychotic agent used for refractory schizophrenia. It has a relatively low affinity for D2 receptors and thus is associated with a lower incidence of extrapyramidal side effects when compared with typical antipsychotics. Clozapine as monotherapy can induce a rare, but serious, blood dyscrasia called agranulocytosis; however, some concomitant medications may contribute to the risk. Examples of these medications are mood-stabilizing antiepileptic drugs, such as carb...

  10. Concomitant nodal involvement by Langerhans cell histiocytosis and Hodgkin's lymphoma.

    Science.gov (United States)

    Geurten, Claire; Thiry, Albert; Jamblin, Paul; Demarche, Martine; Hoyoux, Claire

    2015-12-01

    A 10-year-old girl with a family history of Hodgkin's lymphoma presented with a 2 month history of cervical lymphadenopathy and weight loss. Biopsy indicated concomitant nodal involvement by Langerhans cell histiocytosis and Hodgkin's lymphoma. Such an association is rare, especially so in children, but is not an isolated phenomenon, thereby prompting the question of whether Langerhans cell histiocytosis is a reactive or a neoplastic process. PMID:26556799

  11. Feasibility of capecitabine immunotherapy in a taxane-refractory metastatic breast cancer patient: A rural cancer hospital experience

    Directory of Open Access Journals (Sweden)

    Vivek Tiwari

    2014-05-01

    Full Text Available To manage a metastatic cancer patient in a rural setting is a daunting task owing to the lack of resources and infrastructure. Intravenous chemotherapy (CT, with its debilitating side effects, often causes a decrease in the quality of life (QOL of the patient. When the treatment is of palliative intent, efforts should be made to provide maximum symptom relief to the patient, striking a balance between the patient’s wishes and a sound scientific rationale. We describe our experience with a patient with extensively metastatic breast cancer treated in our rural center with single-agent oral capecitabine, without development of any severe toxicity and with a significant improvement in disease process and patient’s performance status (PS.

  12. Feasibility of capecitabine monotherapy in a taxane refractory metastatic breast cancer patient: A rural cancer hospital experience

    Directory of Open Access Journals (Sweden)

    Vivek Tiwari

    2014-05-01

    Full Text Available To manage a metastatic cancer patient in a rural setting is a daunting task owing to the lack of resources and infrastructure. Intravenous chemotherapy (CT, with its debilitating side effects often causes a decrease in the quality of life (QOL of the patient. When the treatment is of palliative intent, efforts should be made to provide maximum symptom relief to the patient striking a balance between the patient’s wishes and a sound scientific rationale. We describe our experience with a patient with extensively metastatic breast cancer treated in our rural center with single agent oral capecitabine, without development of any severe toxicity and with a significant improvement in disease process and patient’s performance status (PS

  13. Vacuum Ultraviolet Photoionization and Dissociative Photoionization of Capecitabine, 5'-Deoxy-5-fluorocytidine, and 5′-Deoxy-5-fluorouridine

    Institute of Scientific and Technical Information of China (English)

    Jian Wang; Wen-jian Tang; Li-li Ye; Li-dong Zhang; Yang Pan

    2013-01-01

    Vacuum ultraviolet (VUV) photoionization and dissociative photoionization of capecitabine and its metabolites,5′-deoxy-5-fluorocytidine (5′-DFCR) and 5'-deoxy-5-fluorouridine (5′-DFUR),were investigated with infrared laser desorption/tunable synchrotron VUV photoionization mass spectrometry.Molecular ions (M+) with small amounts of fragments can be found for these compounds at relatively low photon energies,while more fragment ions would be produced by increasing the photon energies.(M-H2O)+,(base+H)+,(base+2H)+,(base+30)+,(base+60)+,and sugar moiety were proposed for these nucleoside drugs with similar backbones.Decomposition channels for the major fragments were discussed in detail.Moreover,ab initio calculations were introduced to study the dehydration pathways of three fluoro-nucleosides.Corresponding appearance energies for the (M-H2O)+ ions were computed.

  14. Coagulopathy as initial manifestation of concomitant celiac disease and cystic fibrosis: a case report

    OpenAIRE

    Zdraveska Nikolina; Kostovski Aco

    2011-01-01

    Abstract Introduction Celiac disease and cystic fibrosis have many common manifestations, such as malabsorption, steatorrhea and growth failure, and were for many years recognized as one clinical entity. Since their recognition as two separate diseases, their co-existence in a patient has been described sporadically; around 20 cases have been described in the literature. Taking into consideration the incidences of the two diseases, the chance of them occurring together is one in 2,000,000 in ...

  15. Lapatinib plus capecitabine in treating HER2-positive advanced breast cancer: efficacy, safety, and biomarker results from Chinese patients

    Institute of Scientific and Technical Information of China (English)

    Bing-He Xu; Beth Newstat; Alka Preston; Anne-Marie Martin; Hai-Dong Chi; Li Wang; Ze-Fei Jiang; Daniel Chua; Zhi-Min Shao; Rong-Cheng Luo; Xiao-Jia Wang; Dong-Geng Liu; Winnie Yeo; Shi-Ying Yu

    2011-01-01

    Overexpression of human epidermal growth factor receptor-2 (HER2) in metastatic breast cancer (MBC) is associated with poor prognosis. This single-arm open-label trial (EGF109491; NCT00508274) was designed to confirm the efficacy and safety of lapatinib in combination with capecitabine in 52 heavily pretreated Chinese patients with HER2-positive MBC. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included progression-free survival (PFS), time to response (TTR), duration of response (DoR), central nervous system (CNS) as first site of relapse, and safety. The results showed that there were 23 patients with partial responses and 7 patients with stable disease, resulting in a CBR of 57.7%. The median PFS was 6.34 months (95% confidence interval, 4.93-9.82 months). The median TTR and DoR were 4.07 months (range, 0.03-14.78 months) and 6.93 months (range, 1.45-9.72 months), respectively. Thirteen (25.0%) patients had new lesions as disease progression. Among them, 2 (3.8%) patients had CNS disease reported as the first relapse. The most common toxicities were palmar-plantar erythrodysesthesia (59.6%), diarrhea (48.1%), rash (48.1%), hyperbilirubinemia (34.6%), and fatigue (30.8%). Exploratory analyses of oncogenic mutations of PIK3CA suggested that of 38 patients providing a tumor sample, baseline PIK3CA mutation status was not associated with CBR (P = 0.639) or PFS (P = 0.989). These data confirm that the lapatinib plus capecitabine combination is an effective and well-tolerated treatment option for Chinese women with heavily pretreated MBC, irrespective of PIK3CA status.

  16. Bevacizumab, Capecitabine, Amifostine, and Preoperative Hypofractionated Accelerated Radiotherapy (HypoArc) for Rectal Cancer: A Phase II Study

    International Nuclear Information System (INIS)

    Purpose: Bevacizumab has established therapeutic activity in patients with metastatic colorectal cancer, and anti-vascular endothelial growth factor therapy enhances the activity of radiotherapy in experimental models. We assessed the feasibility and efficacy of preoperative radiochemotherapy combined with bevacizumab in patients with rectal cancer. Methods and Materials: Nineteen patients with radiologic T3 and/or N+ rectal carcinoma were treated with preoperative conformal hypofractionated accelerated radiotherapy (3.4 Gy in 10 consecutive fractions) supported with amifostine (500-1,000 mg daily), capecitabine (600 mg/m2 twice daily, 5 days per week), and bevacizumab (5 mg/kg every 2 weeks for 2 cycles). Surgery followed 6 weeks after the end of radiotherapy. A cohort of 14 sequential patients treated with the same regimen without bevacizumab was available for comparison. Results: Grade 2 or 3 diarrhea was noted in 7 of 19 patients (36.8%), which was statistically worse than patients receiving the same regimen without bevacizumab (p = 0.01). A higher incidence of Grade 2 or 3 proctalgia was also noted (21.1%) (p = 0.03). Bladder and skin toxicity was negligible. All toxicities regressed completely within 2 weeks after the end of therapy. Pathologic complete and partial response was noted in 7 of 19 cases (36.8%) and 8 of 19 cases (42.1%). Within a median follow-up of 21 months, none of the patients has had late complications develop and only 1 of 18 evaluable cases (5.5%) has had locoregional relapse. Conclusions: Bevacizumab can be safely combined with hypofractionated radiotherapy and capecitabine as a preoperative radiochemotherapy regimen for patients with rectal cancer. The high pathologic complete response rates urges the testing of bevacizumab in randomized studies.

  17. Postoperative Chemotherapy Followed by Conformal Concomitant Chemoradiotherapy in High-Risk Gastric Cancer

    International Nuclear Information System (INIS)

    Purpose: To analyze the efficacy, toxicity, and pattern of relapse after adjuvant cisplatin-based chemotherapy followed by three-dimensional irradiation and concomitant LV5FU2 chemotherapy (high-dose leucovorin and 5-fluorouracil bolus plus continuous infusion) in the treatment of completely resected high-risk gastric cancer. Methods and Materials: This was a retrospective analysis of 52 patients with high-risk gastric cancer initially treated by total/partial gastrectomy and lymphadenectomy between January 2002 and June 2007. Median age was 54 years (range, 36–75 years). Postoperative treatment consisted of 5-fluorouracil and cisplatin chemotherapy. Adjuvant chemotherapy was followed by three-dimensional conformal radiotherapy in the tumor bed and regional lymph nodes at 4500 cGy/25 fractions in association with concomitant chemotherapy. Concomitant chemotherapy consisted of a 2-h infusion of leucovorin (200 mg/m²) followed by a bolus of 5-fluorouracil (400 mg/m²) and then a 44-h continuous infusion of 5-fluorouracil (2400–3600 mg/m²) given every 14 days, for three cycles (LV5FU2 protocol). Results: Five-year overall and disease-free survival were 50% and 48%, respectively. Distant metastases and peritoneal spread were the most frequent sites of relapse (37% each). After multivariate analysis, only pathologic nodal status was significantly associated with disease-free and overall survival. Acute toxicities were essentially gastrointestinal and hematologic. One myocardial infarction and one pulmonary embolism were also reported. Eighteen patients had a radiotherapy program interruption because of acute toxicity. All patients but 2 have completed radiotherapy. Conclusion: Postoperative cisplatin-based chemotherapy followed by conformal radiotherapy in association with concurrent 5-fluorouracil seemed to be feasible and resulted in successful locoregional control.

  18. Postoperative Chemotherapy Followed by Conformal Concomitant Chemoradiotherapy in High-Risk Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Quero, Laurent, E-mail: laurent.quero@sls.aphp.fr [Department of Radiation Oncology, Saint-Louis Hospital, Paris (France); Bouchbika, Zineb; Kouto, Honorine; Baruch-Hennequin, Valerie [Department of Radiation Oncology, Saint-Louis Hospital, Paris (France); Gornet, Jean-Marc [Department of Gastroenterology, Saint-Louis Hospital, Paris (France); Munoz, Nicolas [Department of General Surgery, Saint-Louis Hospital, Paris (France); Cojean-Zelek, Isabelle [Department of Medical Oncology, Croix Saint-Simon Hospital, Paris (France); Houdart, Remi [Department of Digestive Surgery, Croix Saint-Simon Hospital, Paris (France); Panis, Yves [Department of Colorectal Surgery, Beaujon Hospital, Clichy (France); Valleur, Patrice [Department of Digestive Surgery, Lariboisiere Hospital, Paris (France); Aparicio, Thomas [Department of Gastroenterology, Avicenne Hospital, Bobigny (France); Maylin, Claude; Hennequin, Christophe [Department of Radiation Oncology, Saint-Louis Hospital, Paris (France)

    2012-06-01

    Purpose: To analyze the efficacy, toxicity, and pattern of relapse after adjuvant cisplatin-based chemotherapy followed by three-dimensional irradiation and concomitant LV5FU2 chemotherapy (high-dose leucovorin and 5-fluorouracil bolus plus continuous infusion) in the treatment of completely resected high-risk gastric cancer. Methods and Materials: This was a retrospective analysis of 52 patients with high-risk gastric cancer initially treated by total/partial gastrectomy and lymphadenectomy between January 2002 and June 2007. Median age was 54 years (range, 36-75 years). Postoperative treatment consisted of 5-fluorouracil and cisplatin chemotherapy. Adjuvant chemotherapy was followed by three-dimensional conformal radiotherapy in the tumor bed and regional lymph nodes at 4500 cGy/25 fractions in association with concomitant chemotherapy. Concomitant chemotherapy consisted of a 2-h infusion of leucovorin (200 mg/m Superscript-Two ) followed by a bolus of 5-fluorouracil (400 mg/m Superscript-Two ) and then a 44-h continuous infusion of 5-fluorouracil (2400-3600 mg/m Superscript-Two ) given every 14 days, for three cycles (LV5FU2 protocol). Results: Five-year overall and disease-free survival were 50% and 48%, respectively. Distant metastases and peritoneal spread were the most frequent sites of relapse (37% each). After multivariate analysis, only pathologic nodal status was significantly associated with disease-free and overall survival. Acute toxicities were essentially gastrointestinal and hematologic. One myocardial infarction and one pulmonary embolism were also reported. Eighteen patients had a radiotherapy program interruption because of acute toxicity. All patients but 2 have completed radiotherapy. Conclusion: Postoperative cisplatin-based chemotherapy followed by conformal radiotherapy in association with concurrent 5-fluorouracil seemed to be feasible and resulted in successful locoregional control.

  19. Concomitant pilocarpine during head and neck irradiation is associated with decreased posttreatment xerostomia

    International Nuclear Information System (INIS)

    Purpose: To retrospectively compare subjective postirradiation xerostomia scores of patients who received concomitant oral pilocarpine during radiotherapy for head and neck cancer and 3 months thereafter with those of similar cohorts who did not receive pilocarpine. Methods and Materials: Subjective xerostomia was assessed using a visual analog scale xerostomia questionnaire that measured oral dryness, oral comfort, difficulty with sleep, speech, and eating. The concomitant pilocarpine group had both parotid glands in the initial field treated to at least 45 Gy and received 5 mg pilocarpine hydrochloride four times per day (q.i.d.) beginning on the first day of radiotherapy and continuing for 3 months after completion of radiation. The control cohort had also received at least 45 Gy to both parotid glands and had not received pilocarpine at the time of evaluation. Scores on the visual analog scale were averaged and compared using the Student's t-test. Results: Seventeen patients who received concomitant pilocarpine during head and neck irradiation and 18 patients who had not been treated with pilocarpine were available for follow-up. The mean intervals between completion of radiation and evaluation of xerostomia were 17 months and 16 months, respectively. Only one of the pilocarpine-treated patients was still taking pilocarpine at the time of evaluation. For each of the individual components of xerostomia scored on the visual analog scale, as well as the composite of all components, the group that had received oral pilocarpine during radiation had significantly less xerostomia (p < 0.01 for each). Conclusions: The use of 5 mg oral pilocarpine q.i.d. during radiotherapy for head and neck cancer and 3 months thereafter was associated with significantly less subjective xerostomia than that reported by a similar cohort of patients who had not received pilocarpine. The continued use of pilocarpine does not appear to be necessary to maintain this benefit in most patients

  20. Capecitabine-related intracranial hypotension syndrome mimicking dural metastasis in a breast cancer patient: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Cosar-Alas Rusen

    2010-01-01

    Full Text Available Spontaneous intracranial hypotension (SICH is an entity, which is secondary to iatrogenic manipulation and breaching of dura. Postural headache in patients should be suspected, cranial magnetic resonance imaging (MRI is essential for precise diagnosis. Hallmark of MRI is regular shape of pachymeningeal gadolinium enhancement and subdural effusion. It may mimic central nervous system (CNS metastasis. Prevention of such cases from receiving cranial radiotherapy by misinterpretation of the gadolinium enhancement as CNS metastasis is an important issue. Capecitabine is an antineoplastic agent, of which metabolites can cross blood-brain barrier in CNS via epithelial tissue. It may cause decrease in CSF production. SICH might be the clinical reflection of this decrease in CSF production. Review of the English literature revealed limited data because of the very little experience with oncologic patients suffering from intracranial hypotension. We report a case of spontaneous intracranial hypotension during capecitabine treatment. Patient was completely well following drug discontinuation and supportive treatment.

  1. Phase I study of short-time oxaliplatin, capecitabine and epirubicin (EXE) as first line therapy in patients with non-resectable gastric cancer

    DEFF Research Database (Denmark)

    Dupont, Jeanette; Jensen, Helle A; Jensen, Benny V;

    2007-01-01

    1; escalating doses of capecitabine (1,000 to 1,250 mg/m2/day continuously) and escalating doses of oxaliplatin (85 to 130 mg/m2 day 1 as a 30 minutes infusion). Cycles were repeated every 21 days for a maximum of 8 cycles. From June 2003 to June 2004, 31 patients were treated. Median age was 61......-8), median survival was 9.2 months and median TTP was 7.5 months. A combination of epirubicin 50 mg/m2 day 1, capecitabine 1,000 mg/m2 continuously and oxaliplatin 130 mg/m2 day 1 each 3 weeks is an easily administered and well tolerated out-patient regimen for patients with non-resectable gastric cancer....

  2. Combination therapies with oxaliplatin and oral capecitabine or intravenous 5-FU show similar toxicity profiles in gastrointestinal carcinoma patients if hand-food syndrome prophylaxis is performed continuously.

    Science.gov (United States)

    Wehler, Thomas C; Cao, Yang; Galle, Peter R; Theobald, Matthias; Moehler, Markus; Schimanski, Carl C

    2012-06-01

    The use of anticancer drugs in palliative settings is often limited by their severe toxic effects. In gastrointestinal carcinomas the 5-fluorouracil-based palliative regimen FOLFOX-4 is often preferred to the equally effective, but more convenient oral capecitabine-based regimen XELOX. This preference is mainly based on the fact that the highly effective oral agent capecitabine induces hand-foot syndrome (HFS). In this study, we investigated whether the continuous administration of skin prophylaxis (10% urea, panthenol, bisabolol, vitamin A, C and E) is capable of protecting against capecitabine-induced HFS and allowing a more convenient oral therapeutic option. In this retrospective analysis, the toxicity profiles, according to NCI CTCAE 3.0 criteria, of 54 patients with gastrointestinal cancer who received either XELOX (34 patients) or FOLFOX-4 (20 patients) were compared using Fisher tests. The treatment protocols that were compared, herein, did not differ significantly in the majority of the analyzed items, with the exception of increased nausea (XELOX-70), fatigue (XELOX-130) and tumor pain (XELOX-70 and XELOX-130). No significant differences were observed among the various groups with regard to emesis, diarrhea, mucositis, exanthema, alopecia, loss of weight and the incidence of infections. In particular, no significant differences in toxicity levels occurred in terms of dose, and HFS was limited if skin prophylaxis was performed continuously. XELOX-based palliative regimens provide an equally effective and comparably toxic therapeutic alternative to FOLFOX-4 if HFS prophylaxis is performed continuously. Since the oral administration of capecitabine is a more convenient method of application, it provides patients with a quality of life-preserving therapeutic alternative. PMID:22783416

  3. Correlation of HER2, p95HER2 and HER3 expression and treatment outcome of lapatinib plus capecitabine in her2-positive metastatic breast cancer.

    Directory of Open Access Journals (Sweden)

    Sae-Won Han

    Full Text Available BACKGROUND: Lapatinib plus capecitabine is an effective treatment option for trastuzumab-refractory HER2-positive metastatic breast cancer. We have investigated the correlation between quantitative measures of HER2, p95HER2, and HER3 and treatment outcomes using lapatinib and capecitabine. METHODS: Total HER2 (H2T, p95HER2 (p95, and total HER3 (H3T expression were quantified in formalin-fixed paraffin-embedded samples using the VeraTag assays. Patients received lapatinib and capecitabine treatment following trastuzumab failure according to the Lapatinib Expanded Access Program. The association between the protein expression levels and clinical outcomes was analyzed. RESULTS: A total of 52 patients were evaluable. H2T level was significantly higher in responders (median 93.49 in partial response, 47.66 in stable disease, and 17.27 in progressive disease; p = 0.020. Longer time-to-progression (TTP was observed in patients with high H2T [p = 0.018, median 5.2 months in high (>14.95 vs. 1.8 in low (0.605 vs. 2.2 in low (<0.605]. Patients having both high H2T and high H3T had significantly longer TTP [adjusted hazard ratio (HR 0.38 (95% CI 0.20-0.73, p = 0.004] and overall survival [adjusted HR 0.46 (95% CI 0.24-0.89, p = 0.020]. No significant association between p95 and response or survival was observed. CONCLUSIONS: These data suggest a correlation between high HER2 and high HER3 expression and treatment outcome, while no significant difference was observed between clinical outcome and p95 expression level in this cohort of HER2-positive, trastuzumab-refractory metastatic breast cancer patients treated with lapatinib and capecitabine.

  4. Interim assessment of prospective phase Ⅱ trial evaluating efficacy of intensity-modulated radiotherapy with concurrent capecitabine for stage Ⅱ/Ⅲ gastric cancer after radical surgery

    International Nuclear Information System (INIS)

    Objective: To evaluate the preliminary efficacy and acute toxicities of intensity-modulated radiotherapy (IMRT) with concurrent capecitabine for stage Ⅱ/Ⅲ gastric cancer (AJCC 7th) after radical surgery and to decide whether to continue phase Ⅱ trial. Methods: From 2009 to 2011, 35 patients with gastric cancer (10 stage Ⅱ patients and 25 stage Ⅲ patients) were included in prospective phase Ⅱ trial to receive chemoradiotherapy. In radiotherapy, the patients received IMRT to the anastomosis,tumor bed, and regional lymph nodes at a dose of 45 Gy/25 fractions. In concurrent chemotherapy, the patients received capecitabine at 1 600 mg/m2 in two divided doses per day for 5 weeks; in adjuvant chemotherapy, the patients received fluorouracil or capecitabine ± oxaliplatin (4-8 cycles). The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for univariate prognostic analysis. A disease-free survival (DFS) of 52.9% was used as the lower limit for continuing study. Results: With a median follow-up of 21 months, the follow-up rate was 94%. Radiotherapy was not completed in 3 patients. The 2-year DFS and overall survival (OS) were 70% and 86%, respectively. The incidence rates of grade 3 acute gastrointestinal, hematologic, and overall toxicities were 11%, 11%, and 26%, respectively. The prognostic analysis showed that signet-ring cell carcinoma and positive lymph node ratio were adverse prognostic factors for DFS, and advanced T stage (T4) was the adverse prognostic factor for OS. Conclusions: The 2-year DFS was greater than 52.9% among all patients with gastric cancer who received IMRT with concurrent capecitabine after radical surgery, and the toxicities were tolerable. Thus, phase Ⅱ trial could be continued. (authors)

  5. Simvastatin sensitizes human gastric cancer xenograft in nude mice to capecitabine by suppressing nuclear factor-kappa B-regulated gene products.

    Science.gov (United States)

    Manu, Kanjoormana A; Shanmugam, Muthu K; Li, Feng; Chen, Luxi; Siveen, Kodappully Sivaraman; Ahn, Kwang Seok; Kumar, Alan Prem; Sethi, Gautam

    2014-03-01

    Chemoresistance remains a major problem in the treatment of gastric cancer patients. Hence, novel pharmacological agents that can overcome drug resistance are urgently required. Whether simvastatin can sensitize the gastric cancer to the antitumor effects of capecitabine in vitro and in vivo was investigated. The effect of simvastatin on the proliferation of gastric cancer cells was examined by mitochondrial dye-uptake 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method, apoptosis by esterase staining, NF-κB activation by DNA binding assay, and protein expression by western blot analysis. The effect of simvastatin on the tumor growth in xenograft mouse model of human gastric cancer was also examined. Simvastatin suppressed the proliferation of gastric cancer cells, enhanced the apoptotic effects of capecitabine, suppressed the constitutive activation of NF-κB, and abrogated the expression of cyclooxygenase-2 (COX-2), cyclin D1, Bcl-2, survivin, CXC motif receptor 4, and MMP-9 proteins. In a xenograft mouse model, we observed that the administration of simvastatin alone (5 mg/kg body weight, intraperitoneal thrice/week) significantly suppressed the growth of the tumor and this effect was further potentiated by capecitabine treatment. As compared to the vehicle control, simvastatin also suppressed the expression of NF-κB-regulated gene products such as cyclin D1, COX-2, ICAM-1, MMP-9, survivin, Bcl-xL, and XIAP in tumor tissues. Overall, our results demonstrate that simvastatin can enhance the effects of capecitabine through suppression of NF-κB-regulated markers of proliferation, invasion, angiogenesis, and metastasis. PMID:24233024

  6. Concomitant boost radiotherapy for squamous carcinoma of the tonsillar fossa

    International Nuclear Information System (INIS)

    Purpose: To assess the efficacy of a concomitant boost fractionation schedule of radiotherapy for treating patients with squamous carcinoma of the tonsillar fossa. Patients and Methods: Between December 1983 and November 1992, 83 patients with squamous carcinoma of the tonsil were treated with concomitant boost fractionation. The distribution of American Joint Committee on Cancer T stages was TX-4, T1-5, T2-29, T3-41, T4-4; N stages were NX-1, N0-26, N1-13, N2-31, N3-12. Patients were treated with standard large fields to 54 Gy in 6 weeks. The boost treatment consisted of a second daily 1.5 Gy fraction for 10-12 fractions, usually delivered during the final phase of treatment. The tumor dose was 69-72 Gy, given over 6 weeks. Twenty-one patients, who all had N2 or N3 regional disease, underwent neck dissections, either before (13 patients) or 6 weeks after radiotherapy (8 patients); the other patients were treated with radiotherapy alone. Results: The 5-year actuarial disease-specific survival and overall survival rates were 71 and 60%, respectively. Patients with T2 and T3 primary tumors had 5-year actuarial local control rates of 96 and 78%, respectively. Patients with T3 disease who received the final-phase boost had a 5-year actuarial local control rate of 82%. Actuarial 5-year regional disease control rates were N0, 92%; N1, 76%; N2, 89%; and N3, 89%. The 21 patients who had neck dissections all had their disease regionally controlled. Patients presenting with nodal disease or after a node excision who were treated with radiation alone had a 5-year actuarial regional disease control rate of 79%. All but five patients had confluent Grade 4 mucositis during treatment. Severe late complications attributable to radiation included mandibular necrosis, in-field osteosarcoma, and chronic dysphagia for solid foods. Conclusions: High rates of local and regional disease control were achieved with the concomitant boost fractionation schedule, with few cases of severe late

  7. Concomitant Graves' disease and Hashimoto's thyroiditis, presenting as primary hypothyroidism.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Hypothyroidism in patients with Graves\\' disease is usually the result of ablative treatment. We describe a 58 year old man with Graves\\' ophthalmopathy and pre-tibial myxoedema, who presented with spontaneous primary hypothyroidism. Circulating TSH receptor antibody activity was increased, while thyroid microsomal antibody was detectable in titres greater than one in one hundred thousand. It is likely that the TSH receptor antibody of Graves\\' disease was ineffective in stimulating hyperthyroidism because of concomitant thyroid destruction due to Hashimoto\\'s disease. Alternatively, primary hypothyroidism could have resulted from the effects of a circulating TSH receptor blocking antibody.

  8. Efficacy of concomitant use of dexmedetomidine and propofol in tetanus.

    Science.gov (United States)

    Miya, Ken; Shimojo, Nobutake; Koyama, Yasuaki; Enomoto, Yuki; Hagiya, Keiichi; Yamasaki, Yuichiro; Nishino, Tomofumi; Kawano, Satoru; Mizutani, Taro

    2015-12-01

    Tetanus is an infectious disease caused by Clostridium tetani, which manifests systemic convulsion and autonomic instability associated with high case fatality. Despite proper medical intervention, management of those symptoms is often difficult. We report a case of 67-year-old man with tetanus in which a concomitant use of dexmedetomidine, an adrenaline α-2 receptor agonist, and propofol, a GABA(A) receptor binding agent, was successful in the management of systemic convulsion and autonomic instability without necessitating conventional anticonvulsant, neuromuscular blocking agents, or tracheostomy. PMID:25989896

  9. Concomitant Persistent Pain in Classical Trigeminal Neuralgia – Evidence for Different Subtypes

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes; Bendtsen, Lars

    2014-01-01

    OBJECTIVE: To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype. BACKGROUND: There has been much debate about the possible pathophysiological...

  10. Rhizopus arrhizus and Fusarium solani Concomitant Infection in an Immunocompromised Host.

    Science.gov (United States)

    de Almeida Júnior, João N; Ibrahim, Karim Y; Del Negro, Gilda M B; Bezerra, Evandro D; Duarte Neto, Amaro N; Batista, Marjorie V; Siciliano, Rinaldo F; Giudice, Mauro C; Motta, Adriana L; Rossi, Flávia; Pierrotti, Ligia C; Freire, Maristela P; Bellesso, Marcelo; Pereira, Juliana; Abdala, Edson; Benard, Gil

    2016-02-01

    Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected. PMID:26346377

  11. Re-irradiation combined with capecitabine in locally recurrent squamous cell carcinoma of the head and neck. A prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Vormittag, L.; Kornek, G. [Medical Univ. Vienna (Austria). Div. of Clinical Oncology; Lemaire, C.; Radonjic, D.; Selzer, E. [Medical Univ. Vienna (Austria). Dept. for Radiotherapy and Radiobiology

    2012-03-15

    We performed a prospective phase II trial to investigate the safety and efficacy of radiotherapy combined with capecitabine in patients suffering from a recurrence of a squamous cell carcinoma of the head and neck (SCCHN) within a previously irradiated field. A total of 31 evaluable patients with recurrent SCCHN received re-irradiation with a total dose of 50 Gy (25 fractions over 5 weeks) up to a maximum of 60 Gy combined with 900 mg/m{sup 2}/day capecitabine given on the days of radiotherapy. The median time to relapse after the first course of radiotherapy was 15 months. The overall response rate in our study was 68% including 6 patients with a complete response. The median overall survival was 8.4 months. Grade 3 or 4 mucositis occurred in 4 patients and 1 patient, respectively. No grade 4 hematological toxicities were observed; 1 patient had grade 3 anemia. The cumulative median lifetime dose was 116 Gy. Capecitabine combined with re-irradiation is a well-tolerated treatment in patients with recurrent SCCHN. In light of its good tolerability, it appears to be a potential option for patients with a reduced performance status and may also serve as a basis for novel treatment concepts, such as in combination with targeted therapies.

  12. Valproic acid potentiates the anticancer activity of capecitabine in vitro and in vivo in breast cancer models via induction of thymidine phosphorylase expression

    Science.gov (United States)

    Terranova-Barberio, Manuela; Roca, Maria Serena; Zotti, Andrea Ilaria; Leone, Alessandra; Bruzzese, Francesca; Vitagliano, Carlo; Scogliamiglio, Giosuè; Russo, Domenico; D'Angelo, Giovanni; Franco, Renato; Budillon, Alfredo; Di Gennaro, Elena

    2016-01-01

    The prognosis of patients with metastatic breast cancer remains poor, and thus novel therapeutic approaches are needed. Capecitabine, which is commonly used for metastatic breast cancer in different settings, is an inactive prodrug that takes advantage of elevated levels of thymidine phosphorylase (TP), a key enzyme that is required for its conversion to 5-fluororacil, in tumors. We demonstrated that histone deacetylase inhibitors (HDACi), including low anticonvulsant dosage of VPA, induced the dose- and time-dependent up-regulation of TP transcript and protein expression in breast cancer cells, but not in the non-tumorigenic breast MCF-10A cell line. Through the use of siRNA or isoform-specific HDACi, we demonstrated that HDAC3 is the main isoform whose inhibition is involved in the modulation of TP. The combined treatment with capecitabine and HDACi, including valproic acid (VPA), resulted in synergistic/additive antiproliferative and pro-apoptotic effects in breast cancer cells but not in TP-knockout cells, both in vitro and in vivo, highlighting the crucial role of TP in the synergism observed. Overall, this study suggests that the combination of HDACi (e.g., VPA) and capecitabine is an innovative antitumor strategy that warrants further clinical evaluation for the treatment of metastatic breast cancer. PMID:26735339

  13. Report on short-term side effects of treatments with {sup 177}Lu-octreotate in combination with capecitabine in seven patients with gastroenteropancreatic neuroendocrine tumours

    Energy Technology Data Exchange (ETDEWEB)

    Essen, Martijn van; Kam, Boen L.; Kwekkeboom, Dik J. [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Krenning, Eric P. [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Erasmus MC, Department of Internal Medicine, Rotterdam (Netherlands); Herder, Wouter W. de; Aken, Maarten O. van [Erasmus MC, Department of Internal Medicine, Rotterdam (Netherlands)

    2008-04-15

    Treatment with the radiolabelled somatostatin analogue {sup 177}Lu-octreotate results in tumour remission in 47% of patients with gastroenteropancreatic neuroendocrine tumours. Adding capecitabine to {sup 177}Lu-octreotate, as a radio-sensitiser, may enhance these anti-tumour effects. We now present the short-term toxicity profile of this novel combination. Seven patients were treated with 7.4 GBq {sup 177}Lu-octreotate and capecitabine (1650 mg/m{sup 2} per day) for 2 weeks with an intended number of four cycles. Toxicity, and especially haematological and renal parameters, were monitored on a weekly basis for the first two cycles and 4 and 6 weeks after subsequent cycles. None of the patients had hand-foot syndrome. One patient had grade 1 stomatitis occurring after one of four cycles. Grade 3 or 4 leukopenia or neutropenia did not occur. One patient had grade 3 anaemia, but none had grade 4 anaemia. One patient had grade 2 thrombocytopenia after the fourth cycle, and one had grade 3 thrombocytopenia. Grade 4 thrombocytopenia did not occur. No significant changes in serum creatinine levels were observed. None of the patients had symptoms of cardiac ischaemia. Treatment with the combination of {sup 177}Lu-octreotate and capecitabine was feasible and safe considering acute and subacute side effects. We therefore started a randomised, controlled clinical trial to compare this combination with {sup 177}Lu-octreotate as single agent with regard to anti-tumour effects and side effects. (orig.)

  14. Concurrent chemoradiation of metastases with capecitabine and oxaliplatin and 3D-CRT in patients with oligometastatic colorectal cancer: results of a phase I study

    Directory of Open Access Journals (Sweden)

    Dellas Kathrin

    2012-06-01

    Full Text Available Abstract Background Local control appears to be an important treatment aim in patients with limited metastases (oligometastases of colorectal cancer (CRC. Those patients show a favourable prognosis, if - in addition to the local effective treatment - an occurrence of new metastases may also be postponed by effective systemic therapy. The purpose of this dose escalation phase I study was to establish the efficacy of local radiotherapy (RT of oligometastatic CRC with a concurrent standard chemotherapy regimen. Methods Patients with first-, second- or third-line therapy of oligometastatic CRC (1–3 metastases or local recurrence plus max. 2 metastases received capecitabine (825 mg/m2/d BID d 1–14; 22–35 and oxaliplatin (50 mg/m2 d 1, 8, 22, 29. 3D-conformal RT of all metastatic lesions was delivered in 2.0 Gy up to 36 Gy to 50 Gy (3 dose levels. Primary endpoint was the maximal tolerable dose (MTD of RT defined as the level at which two or more of six patients experienced dose-limiting toxicity (DLT. Results Between 09/2004 and 08/2007, 9 patients (7 male, 2 female, 50–74 years were enrolled, 6 patients treated at dose level 1 (36 Gy, 3 patients at dose level 2 (44 Gy. 1 patient from the first cohort experienced DLT (oxaliplatin-related hypersensitivity reaction. No radiation-induced DLT occurred. 6/9 patients achieved objective response (partial remission. One year after initiation, all patients were alive, 6 patients survived (16 to 54 months patients died of tumor progression (14 to 23 months. The phase II part of the trial had to be closed due to recruitment failure. Conclusions Local 3D-CRT to metastatic lesions in addition to standard chemotherapy was feasible, DLT was not documented. 3/9 patients survived for a period of 3.5 to 4.4 years (time at the last evaluation. Radiotherapy of metastatic lesions should be incorporated into subsequent trials.

  15. Chemoradiation With Concomitant Boosts Followed by Radical Surgery in Locally Advanced Cervical Cancer: Long-term Results of the ROMA-2 Prospective Phase 2 Study

    International Nuclear Information System (INIS)

    Purpose: This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials: Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with CBs (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m2, days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m2/daily, orally) during the first 2 and the last 2 weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if >45 pCR were registered (α error = 0.05; β error = 0.1). Results: pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36 months (range: 7-85 months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or 2. Conclusions: Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by radical surgery results in a high rate of pathologically assessed complete response to CRT and a very encouraging

  16. Chemoradiation With Concomitant Boosts Followed by Radical Surgery in Locally Advanced Cervical Cancer: Long-term Results of the ROMA-2 Prospective Phase 2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Ferrandina, Gabriella, E-mail: gabriella.ferrandina@libero.it [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Gambacorta, Antonietta [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Gallotta, Valerio [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Smaniotto, Daniela [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Fagotti, Anna [Gynecologic Surgery, University of Perugia, Terni (Italy); Tagliaferri, Luca [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Foti, Elvira; Fanfani, Francesco [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Autorino, Rosa [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Scambia, Giovanni [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Valentini, Vincenzo [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy)

    2014-11-15

    Purpose: This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials: Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with CBs (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m{sup 2}, days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m{sup 2}/daily, orally) during the first 2 and the last 2 weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if >45 pCR were registered (α error = 0.05; β error = 0.1). Results: pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36 months (range: 7-85 months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or 2. Conclusions: Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by radical surgery results in a high rate of pathologically assessed complete response to CRT and a very

  17. Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Tahami

    2015-09-01

    Full Text Available Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. Method: After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling and microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. Results: The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 year in group 1 and 23.26 points after 6 months and 30.66 after 1 year in group 2, whict was statistically significant (Pvalue

  18. Cystic micropapillary neoplasm of peribiliary glands with concomitant perihilar cholangiocarcinoma.

    Science.gov (United States)

    Uchida, Tsuneyuki; Yamamoto, Yusuke; Ito, Takaaki; Okamura, Yukiyasu; Sugiura, Teiichi; Uesaka, Katsuhiko; Nakanuma, Yasuni

    2016-02-21

    We report a case of a 75-year-old man with cystic micropapillary neoplasm of peribiliary glands detected preoperatively by radiologic examination. Enhanced computed tomography showed a low-density mass 2.2 cm in diameter in the right hepatic hilum and a cystic lesion around the common hepatic duct. Under a diagnosis of perihilar cholangiocarcinoma, right hepatectomy with caudate lobectomy and bile duct resection were performed. Pathological examination revealed perihilar cholangiocarcinoma mainly involving the right hepatic duct. The cystic lesion was multilocular and covered by columnar lining epithelia exhibiting increased proliferative activity and p53 nuclear expression; it also contained foci of micropapillary and glandular proliferation. Therefore, the lesion was diagnosed as a cystic micropapillary neoplasm of peribiliary glands and resembled flat branch-type intraductal papillary mucinous neoplasm of the pancreas. Histological examination showed the lesion was discontinuous with the perihilar cholangiocarcinoma. Immunohistochemistry showed the cystic neoplasm was strongly positive for MUC6 and that the cholangiocarcinoma was strongly positive for MUC5AC and S100P. These results suggest these two lesions have different origins. This case warrants further study on whether this type of neoplasm is associated with concomitant cholangiocarcinoma as observed in pancreatic intraductal papillary mucinous neoplasm with concomitant pancreatic duct adenocarcinoma. PMID:26900302

  19. Stellate nonhereditary idiopathic foveomacular retinoschisis concomitant to exudative maculopathies.

    Science.gov (United States)

    Casalino, G; Upendran, M; Bandello, F; Chakravarthy, U

    2016-05-01

    PurposeTo report the clinical course of patients presenting with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) concomitant with exudative maculopathies.MethodsRetrospective case series. Multimodal imaging findings, including spectral-domain optical coherence tomography (SD-OCT) were reviewed. Genetic testing for the RS1 gene was performed in one patient.ResultsWe identified two female patients who fit the definition of SNIFR and presented with concomitant neovascular age-related macular degeneration (n-AMD). In both the patients, SD-OCT showed exudative macular features and splitting (bilateral in patient 1, unilateral in patient 2) of the outer plexiform layer (OPL) in the macula with no other evidence of hereditary or an acquired predisposing condition. Genetic testing excluded mutation of RS1 gene in patient 1. The fundi of both the patients showed characteristic signs of active choroidal neovascularization (CNV) and following anti-VEGF treatment, visual acuity improved and CNV-related exudative changes resolved. However, the split along the OPL remained unaltered.ConclusionsSNIFR may be associated with n-AMD. It is important to recognise the presence of retinoschisis when there is other exudative pathology as the former may be misinterpreted as intraretinal fluid, prompting unnecessary treatment. PMID:26915743

  20. Organ preservation in stage II and III head and neck cancer utilizing alternate week concomitant chemoradiotherapy

    International Nuclear Information System (INIS)

    Purpose: A prospective phase II trial was conducted to determine the efficacy and rate of organ preservation of alternate week concomitant chemoradiotherapy in stage II and III head and neck cancer. Methods: Forty-nine patients (10 stage II and 39 stage III) with squamous cell carcinoma of the head and neck region have been entered into a prospective phase II trial. Pretreatment evaluation included history and physical examination, computed tomography of the neck, bone scan, chest x-ray, panendoscopy and biopsy confirmation of malignancy. Therapy is given in 2 week cycles consisting of 5 days of concomitant chemoradiotherapy followed by a nine day break during which no treatment is given. Each cycle of treatment consists of 1.0 gm hydroxyurea P.O. every 12 hours for 6 days (11 doses per cycle) and 800mg/m2/d continuous infusion 5-fluorouracil along with concomitant radiation therapy (RT) administered in 1.8-2.0 Gy daily fractions for five days. This alternate week (week on/week off) schedule is continued for a total of 7 cycles resulting in an overall treatment time of 13 weeks and a total RT dose of 70 Gy. Extent of initial surgery included biopsy only (59.2%), minimal laser debulking (12.2%), and resection with or without neck dissection (28.6%). Results: The majority of patients are male (71.4%), with a median age of 61.3 years. Primary sites included oral cavity (16.3%), oropharynx (12.2%), larynx (57.1%), hypopharynx (8.1%), and nasopharynx (4.1%). T stage included T3 (32 patients, 65.3%), T2 (16 patients, 32.7%), and T1 (1 patient). N stage included N1 (17 patients, 34.7%), and N0 (32 patients, 65.3%). With a median follow-up of 27 months, the overall response rate is 100% (91.7 complete response, and 8.3% partial response). The 5 year actuarial local control, disease free survival, and overall survival is 90.1%, 88.3%, and 65.0%, respectively. One patient has failed with distant disease alone. Four patients had isolated local failures and (3(4)) were

  1. Comparison of the effectiveness and toxicity of neoadjuvant chemotherapy regimens, capecitabine/epirubicin/cyclophosphamide vs 5-fluorouracil/epirubicin/cyclophosphamide, followed by adjuvant, capecitabine/docetaxel vs docetaxel, in patients with operable breast cancer

    Directory of Open Access Journals (Sweden)

    Zhang MM

    2016-06-01

    Full Text Available Minmin Zhang,* Wei Wei,* Jianlun Liu, Huawei Yang, Yi Jiang, Wei Tang, Qiuyun Li, Xiaoming Liao Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China *These authors contributed equally to this work Abstract: The aim of this study was to compare the effectiveness and toxicity of neoadjuvant chemotherapy regimens, xeloda/epirubicin/cyclophosphamide (XEC vs 5-fluorouracil/epirubicin/cyclophosphamide (FEC, followed by adjuvant chemotherapy regimens, capecitabine/taxotere (XT vs taxotere (T, in axillary lymph node (LN-positive early-stage breast cancer. In this randomized, Phase III trial, 137 patients with operable primary breast cancer (T2-0, N0-1 who were tested axillary LN positive through aspiration biopsy of axillary LNs were randomized (1:1 to four 3-weekly cycles of XEC or FEC. Patients underwent surgery within 4–6 weeks after the fourth cycle, followed by four adjuvant cycles of 3-weekly XT or T. The primary end point was tumor pathological complete response. Toxicity profiles were secondary objectives. In total, 131 patients had clinical and radiological evaluation of response and underwent surgery. Treatment with XEC led to an increased rate of pathological complete response in primary tumor (18% vs 6%, respectively, P=0.027 and objective remission rate (87% vs 73%, P=0.048 compared to FEC. Clinical complete response occurred in 20% and 7% for XEC and FEC, respectively. Compared to FEC, XEC was associated with more hand-foot syndrome (57% vs 11%, P<0.001 and 3/4 grade nausea/vomiting/diarrhea (30% vs 14%, P=0.034 but less phlebitis (3% vs 14%, P=0.035. XT and T adjuvant chemotherapy regimens were well tolerated: treatment-related 3/4 grade adverse events occurred in 28% and 17% of patients receiving XT and T, respectively. Keywords: breast cancer, capecitabine, docetaxel, neoadjuvant chemotherapy, curative effect, toxic side effects

  2. Results of a phase I study to determine the maximum tolerated dose of capecitabine when given concurrently with radical radiotherapy in the treatment of squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Capecitabine is preferentially converted to 5-fluorouracil within tumours, exploiting the higher levels of thymidine phosphorylase (TP) found in areas of poor perfusion and hypoxia. In addition radiation leads to up regulation of TP expression. To exploit these advantages of capecitabine as a synchronous chemoradiotherapy agent patients with advanced squamous cell carcinoma of the head and neck were recruited into a phase I non-randomised dose finding study. Capecitabine was given twice daily, 7 days a week at a dose starting at 350 mg/m2 bid. Radiotherapy using a beam directed technique was prescribed to 55 Gy in 20 fractions over 4 weeks. A total of 24 patients were treated. Dose-limiting toxicity (grade IV mucositis) was reached at a capecitabine dose of 550 mg/m2 bid. Radiotherapy was completed without delay in all cases. There was no systemic drug related toxicity. Capecitabine offers the prospect of an orally administered drug for use synchronously with radiotherapy, which in doses up to 500 mg/m2 bid is well tolerated

  3. Clinical features of Crohn disease concomitant with ankylosing spondylitis

    Science.gov (United States)

    Liu, Song; Ding, Jie; Wang, Meng; Zhou, Wanqing; Feng, Min; Guan, Wenxian

    2016-01-01

    Abstract Extraintestinal manifestations (EIMs) cause increased morbidity and decreased quality of life in Crohn disease (CD). Ankylosing spondylitis (AS) belongs to EIMs. Very little is known on the clinical features of CD concomitant with AS. This study is to investigate the clinical features of CD patients with AS. We retrospectively collected all CD patients with AS in our hospital, and established a comparison group (CD without AS) with age, sex, and duration of Crohn disease matched. Clinical information was retrieved for comparison. Eight CD + AS patients were identified from 195 CD patients. Sixteen CD patients were randomly selected into comparison group. All CD + AS patients were male, HLA-B27 (+), and rheumatoid factor (−) with an average age of 40.8 ± 4.52 years. Significant correlation between disease activity of CD and AS was revealed (r = 0.857, P = 0.011). Significant correlation between disease activity of CD and functional limitation associated with AS was identified (r = 0.881, P < 0.01). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and globulin were positively correlated to Crohn disease activity index (CDAI), Bath AS disease activity index, and Bath AS functional index(BASFI) scores (r = 0.73–0.93, P < 0.05). Albumin was negatively associated with CDAI and BASFI (r = −0.73 to −0.91, P < 0.05). The ratio of albumin to globulin (Alb/Glo) was significantly related to all 3 scores (r = −0.81 to −0.91, P < 0.05). Male predominance with a 4.12% concomitant incidence of AS is observed in CD patients. Disease activity of CD correlates with disease activity of AS and functional limitation caused by AS. CRP, ESR, and Alb/Glo may serve as biomarkers for disease activity and functional limitation in CD patients concomitant with AS, although future studies are expected. PMID:27428240

  4. Concomitant Hamiltonian and topological structures of extended magnetohydrodynamics

    CERN Document Server

    Lingam, Manasvi; Morrison, Philip J

    2016-01-01

    The paper describes the unique geometric properties of ideal magnetohydrodynamics (MHD), and demonstrates how such features are inherited by extended MHD models, which incorporate two-fluid effects. The helicities and other geometric expressions for these models are presented in a topological context, emphasizing their universal features. Some of the results presented include: the generalized Kelvin circulation theorems, the existence of two Lie-dragged 2-forms, and two concomitant helicities (which can be studied via the Jones polynomial from Chern-Simons theory). The ensuing commonality is traced to the existence of an underlying Hamiltonian structure for all the extended MHD models, exemplified by the presence of a unique noncanonical Poisson bracket, and its associated energy.

  5. Concomitant Hamiltonian and topological structures of extended magnetohydrodynamics

    Science.gov (United States)

    Lingam, Manasvi; Miloshevich, George; Morrison, Philip J.

    2016-07-01

    The paper describes the unique geometric properties of ideal magnetohydrodynamics (MHD), and demonstrates how such features are inherited by extended MHD, viz. models that incorporate two-fluid effects (the Hall term and electron inertia). The generalized helicities, and other geometric expressions for these models are presented in a topological context, emphasizing their universal facets. Some of the results presented include: the generalized Kelvin circulation theorems; the existence of two Lie-dragged 2-forms; and two concomitant helicities that can be studied via the Jones polynomial, which is widely utilized in Chern-Simons theory. The ensuing commonality is traced to the existence of an underlying Hamiltonian structure for all the extended MHD models, exemplified by the presence of a unique noncanonical Poisson bracket, and its associated energy.

  6. Formulation and Evaluation of Colon Specific Drug Delivery System of Capecitabine Containing Polymer Coated Capsule Dosage Form

    Directory of Open Access Journals (Sweden)

    Kathiravan P

    2015-08-01

    Full Text Available In this context, a polymer surface encompassed capsule dosage form of capecitabine was investigated and personalized for colon-targeted delivery of drugs. The sandwich replica of the system was designed by imparting the essences of time-release function and a pH-sensing function to a hard gelatin capsule. The technical traits of the system are fabricated to contain an organic acid together with an active ingredient in a capsule coated with a three-layered film consisting of an acid-soluble polymer, a water-soluble polymer, and an enteric polymer. In order to prioritize the suitable formulation, various formulation factors were investigated through a series of in vitro dissolution studies. The results are complied as: (1 various organic acids can be used for this system invariably; (2 a predictable timed-release mechanism of a drug can be attained by tailoring the thickness of the Eudragit E 100 layer; and (3 the outer enteric coating with CMEC lends acceptable acid-resistibility. The result out comes postulate and suggests that this approach can provide a beneficial and practical means for colon-targeted delivery of drugs. This engineered structure has a proven benefit in various fronts for the end organ (colon, getting optimum concentration of drug to cause the therapeutic improvisation in the segment of malignancy and its associated risks within it.

  7. Concomitant NSAID use during antipsychotic treatment and risk of 2-year relapse - a population-based study of 16,253 incident patients with schizophrenia

    DEFF Research Database (Denmark)

    Köhler, Karl Ole; Petersen, Liselotte; Benros, Michael Eriksen; Mors, Ole; Gasse, Christiane

    OBJECTIVE: Clinical trials have indicated antipsychotic effects of non-steroidal anti-inflammatory drugs (NSAIDs) among incident patients with schizophrenia. We aimed to study, in a population-based setting, whether concomitant use of NSAIDs or paracetamol, changed 2-year relapse risk for...... schizophrenia. METHODS: We identified all incident patients with schizophrenia in Denmark diagnosed 1996-2012 initiating antipsychotic treatment within the year after diagnosis. We calculated concomitant treatment intervals for antipsychotic and NSAID or paracetamol use. Hazard rate ratios (HRR) were estimated...... using Cox regression adjusted for important covariates. MAIN OUTCOME MEASURES: 2-year relapse, i.e. (re)-hospitalizations with schizophrenia. RESULTS: Among 16,235 incident patients with schizophrenia using antipsychotics, 1480 (9.1%) used NSAIDs and 767 (4.7%) paracetamol. Concomitant use of NSAIDs was...

  8. Impact of ileocecal resection and concomitant antibiotics on the microbiome of the murine jejunum and colon.

    Directory of Open Access Journals (Sweden)

    Anthony A Devine

    Full Text Available Ileocecal resection (ICR is a commonly required surgical intervention in unmanageable Crohn's disease and necrotizing enterocolitis. However, the impact of ICR, and the concomitant doses of antibiotic routinely given with ICR, on the intestinal commensal microbiota has not been determined. In this study, wild-type C57BL6 mice were subjected to ICR and concomitant single intraperitoneal antibiotic injection. Intestinal lumen contents were collected from jejunum and colon at 7, 14, and 28 days after resection and compared to non-ICR controls. Samples were analyzed by 16S rRNA gene pyrosequencing and quantitative PCR. The intestinal microbiota was altered by 7 days after ICR and accompanying antibiotic treatment, with decreased diversity in the colon. Phylogenetic diversity (PD decreased from 11.8 ± 1.8 in non-ICR controls to 5.9 ± 0.5 in 7-day post-ICR samples. There were also minor effects in the jejunum where PD values decreased from 8.3 ± 0.4 to 7.5 ± 1.4. PCoA analysis indicated that bacterial populations 28 days post-ICR differed significantly from non-ICR controls. Moreover, colon and jejunum bacterial populations were remarkably similar 28 days after resection, whereas the initial communities differed markedly. Firmicutes and Bacteroidetes were the predominant phyla in jejunum and colon before ICR; however, Firmicutes became the vastly predominant phylum in jejunum and colon 28 days after ICR. Although the microbiota returned towards a homeostatic state, with re-establishment of Firmicutes as the predominant phylum, we did not detect Bacteroidetes in the colon 28 days after ICR. In the jejunum Bacteroidetes was detected at a 0.01% abundance after this time period. The changes in jejunal and colonic microbiota induced by ICR and concomitant antibiotic injection may therefore be considered as potential regulators of post-surgical adaptive growth or function, and in a setting of active IBD, potential contributors to post

  9. Concomitant macro and microvascular complications in diabetic nephropathy

    International Nuclear Information System (INIS)

    To determine the prevalence of concomitant microvascular and macro vascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 + -11.4 years, mean duration of diabetes was 15.4 + -7.5 years, mean age at the onset of nephropathy was 61.5 + - 12.4 years, and mean duration of nephropathy was 3.9 + - 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate

  10. Concomitant physeal fractures of the distal femur and proximal tibia

    International Nuclear Information System (INIS)

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  11. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  12. [Concomitant activity of 2 bunyaviruses in horses in Argentina].

    Science.gov (United States)

    Cámara, A; Contigiani, M S; Medeot, S I

    1990-01-01

    A serologic survey of horses for Kairi (KRI) and Cache Valley (CV), two related Bunyaviruses, was conducted simultaneously in Cordoba and Santa Fe provinces, Argentina, during late 1983 and 1984. The prevalence of neutralizing antibodies only for KRI was 13.3% and only for CV was 40.0%; but if the total positive sera for KRI and CV were taken into account, the prevalence reached 48.3 and 75.0%, respectively. The prevalence for CV was higher than for KRI in Cordoba (p less than 0.01), but both were similar in Santa Fe province. The demonstration of seroconversion in horses of the two zones for both viruses indicates that these viruses have a concomitant activity. The infection rates (number of infections per 100 horses-month) were very high in Cordoba (4.4 and 7.1 for KRI and CV) but also in Santa Fe (2.9 and 9.5 for the two viruses respectively), without significant difference in each province. Despite this high activity, no signs of illness or death imputed to these viruses were registered, in these areas during the period of observation. This apparent absence of associated equine disease may be the consequence of the low or null virus pathogenicity or the underrecognition or underreporting of the clinical cases. PMID:2126879

  13. Delirium and concomitant use of lithium+electroconvulsive therapy (ECT

    Directory of Open Access Journals (Sweden)

    Sadeghi M

    2001-09-01

    Full Text Available Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium+E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D. 1 disorder (manic episode 24 were given E.C.T.+lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001. These findings show that combination of E.C.T. and Lithium may not be so harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

  14. Characterization of Bivariate Distributions Using Concomitants of Generalized (k) Record Values

    OpenAIRE

    Poruthiyudian Yageen Thomas; Philip Anne; Thankachan Geetha Veena

    2014-01-01

    In this paper we have derived some properties of concomitants of generalized (k) record values which characterize the generalized Morgenstern family of bivariate distributions.  The role of concomitants of generalized (k) record values in the unique determination of the parent bivariate distribution has been established.  We have also illustrated how the concomitants of generalized (k) record values characterize the Morgenstern family of bivariate distributions.

  15. Genetic Markers of Toxicity From Capecitabine and Other Fluorouracil-Based Regimens: Investigation in the QUASAR2 Study, Systematic Review, and Meta-Analysis

    Science.gov (United States)

    Rosmarin, Dan; Palles, Claire; Church, David; Domingo, Enric; Jones, Angela; Johnstone, Elaine; Wang, Haitao; Love, Sharon; Julier, Patrick; Scudder, Claire; Nicholson, George; Gonzalez-Neira, Anna; Martin, Miguel; Sargent, Daniel; Green, Erin; McLeod, Howard; Zanger, Ulrich M.; Schwab, Matthias; Braun, Michael; Seymour, Matthew; Thompson, Lindsay; Lacas, Benjamin; Boige, Valérie; Ribelles, Nuria; Afzal, Shoaib; Enghusen, Henrik; Jensen, Søren Astrup; Etienne-Grimaldi, Marie-Christine; Milano, Gérard; Wadelius, Mia; Glimelius, Bengt; Garmo, Hans; Gusella, Milena; Lecomte, Thierry; Laurent-Puig, Pierre; Martinez-Balibrea, Eva; Sharma, Rohini; Garcia-Foncillas, Jesus; Kleibl, Zdenek; Morel, Alain; Pignon, Jean-Pierre; Midgley, Rachel; Kerr, David; Tomlinson, Ian

    2014-01-01

    Purpose Fluourouracil (FU) is a mainstay of chemotherapy, although toxicities are common. Genetic biomarkers have been used to predict these adverse events, but their utility is uncertain. Patients and Methods We tested candidate polymorphisms identified from a systematic literature search for associations with capecitabine toxicity in 927 patients with colorectal cancer in the Quick and Simple and Reliable trial (QUASAR2). We then performed meta-analysis of QUASAR2 and 16 published studies (n = 4,855 patients) to examine the polymorphisms in various FU monotherapy and combination therapy regimens. Results Global capecitabine toxicity (grades 0/1/2 v grades 3/4/5) was associated with the rare, functional DPYD alleles 2846T>A and *2A (combined odds ratio, 5.51; P = .0013) and with the common TYMS polymorphisms 5′VNTR2R/3R and 3′UTR 6bp ins-del (combined odds ratio, 1.31; P = 9.4 × 10−6). There was weaker evidence that these polymorphisms predict toxicity from bolus and infusional FU monotherapy. No good evidence of association with toxicity was found for the remaining polymorphisms, including several currently included in predictive kits. No polymorphisms were associated with toxicity in combination regimens. Conclusion A panel of genetic biomarkers for capecitabine monotherapy toxicity would currently comprise only the four DPYD and TYMS variants above. We estimate this test could provide 26% sensitivity, 86% specificity, and 49% positive predictive value—better than most available commercial kits, but suboptimal for clinical use. The test panel might be extended to include additional, rare DPYD variants functionally equivalent to *2A and 2846A, though insufficient evidence supports its use in bolus, infusional, or combination FU. There remains a need to identify further markers of FU toxicity for all regimens. PMID:24590654

  16. A Retrospective Study of Capecitabine/Temozolomide (CAPTEM Regimen in the Treatment of Metastatic Pancreatic Neuroendocrine Tumors (pNETs after Failing Previous Therapy

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2013-09-01

    Full Text Available Context Pancreatic neuroendocrine tumors (pNETs are notoriously resistant to currently available chemotherapy agents.Preclinical data has suggested synergy between temozolomide and capecitabine. Objective To report a retrospective data on the efficacy and safety of capecitabine and temozolomide (CAPTEM regimen in patients with metastatic pancreaticneuroendocrine tumors (pNETs who have failed prior therapies. Methods We reviewed the medical records of 7 patientswith metastatic pNETs who had had progressive cancer prior to treatment despite therapy, including long-acting releaseoctreotide (60 mg/month, chemotherapy and hepatic chemoembolization. Capecitabine was administered at a flat dose of1,000 mg orally twice daily on days 1-14 and temozolomide 200 mg/m2 was given in two divided doses daily on days 10-14of a 28-day cycle. Tumor assessments were repeated every two cycles and serum tumor markers were measured every cycle. Response to treatment was assessed using Response Evaluation Criteria in Solid Tumors (RECIST parameters, and toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 3.0. Results Among 7 patients treated, three patients achieved a partial response, and two patients had stable disease. Totalresponse rate was 43%, and clinical benefit (responders and stable disease was 71%. Median duration of response was 8months (range: 4-12 months. Grade 3 and 4 toxicities included grade 3 thrombocytopenia in one patient and grade 3 fatigue in one patient. The most common toxicities were grade 1 and 2 neutropenia, grade 1 fatigue, grade 1 and 2 hand-foot syndrome. Conclusions Our retrospective study showed that modified CAPTEM regimen was well-tolerated and produced comparable response to historical data in neuroendocrine tumors, including pNETs. Our study is unique as it only included patients with pNETs. Further prospective studies are warranted to evaluate the combination of

  17. All-oral combination of lapatinib and capecitabine in patients with brain metastases from HER2-positive breast cancer - A phase II study

    International Nuclear Information System (INIS)

    Purpose: Approximately one-third of patients with advanced, HER2+ve breast cancer (BC) develop brain metastases (BMs). The aim of this study is to investigate efficacy and tolerability of the combination of lapatinib and capecitabine (LC) in HER2+ve BC patients with brain metastases (BCBM). Patients and methods: Between January 2011 and January 2013, 21 patients with HER2+ve BCBM were included. Sixteen patients (76.19%) progressed after whole brain radiotherapy (WBRT) and 5 patients (23.81%) were treatment-naive for BM. Patients received lapatinib (1250 mg/day continuously) and capecitabine (2000 mg/m2 on days 1-14 of a 21-day cycle). All patients were treated with trastuzumab either in the adjuvant or metastatic setting. No patients had received prior lapatinib and/or capecitabine. End-points were response rate (RR), progression free survival (PFS), overall survival (OS) and toxicity. Results: The overall response rate (ORR) was 33.3% (7/21) and all were partial response. For patients receiving prior WBRT and patients receiving LC as first line treatment for BCBM the ORR was 31.2% (5/16) and 40.0% (2/5) respectively. Median PFS was 5.5 months. Median OS was 11 months. Treatment-related adverse events were manageable. Grade 3–4 toxicities were hand-foot syndrome (14.3%), diarrhea (14.3%), nausea/vomiting (9.5%), mucositis (4.8%), and skin rash (4.8%). Conclusion: The combination of LC is active and well-tolerated treatment in patients with HER2+ve BCBM.

  18. Phase II study of Pseudomonas aeruginosa-Mannose-Sensitive hemagglutinin in combination with capecitabine for Her-2-negative metastatic breast cancer pretreated with anthracycline and taxane.

    Directory of Open Access Journals (Sweden)

    Fangfang Lv

    Full Text Available Metastatic breast cancer (MBC remains an incurable disease despite major therapeutic advances. Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA has been established to have anti-proliferative effects against breast cancer cells in preclinical experiments, and is indicated for treatment of cancer in China. We performed a phase II trial combining PA-MSHA with capecitabine in patients with heavily pretreated MBC.Eligibility criteria included human epidermal growth factor receptor 2-negative MBC, prior therapy with anthracyclines and taxanes, at least one prior chemotherapy regimen for metastatic disease or early relapse after a taxane plus anthracycline adjuvant regimen, and adequate organ function and performance status. PA-MSHA 1 mg was administered subcutaneously every other day and capecitabine 1000 mg/m2 orally twice a day for 2 weeks on, 1 week off. The primary end point was progression-free survival.A total of 97 patients were enrolled. Median progression-free survival (PFS was 4.0 months [95 % confidence interval (CI 3.0-4.9], which was not significantly different from that in historical controls. However, median PFS was significantly longer (8.2 months; 95 % CI 6.7-9.7 in 24 patients with moderate immune-related adverse events (irAEs such as fever or skin induration at the injection site than in those with no or mild irAEs (3.1 months, 95 % CI 2.5-3.6; p = 0.003. Overall survival was also improved in these patients (25.4 vs. 16.4 months; p = 0.044. PA-MSHA has a good safety profile, with only 6 patients (6.2 % discontinuing treatment. PA-MSHA did not increase capecitabine-related toxicities such as hand-foot syndrome, nausea, and vomiting.Adding PA-MSHA to capecitabine has a good safety profile in patients with heavily pre-treated MBC, although benefit from this regimen might occur only in patients with moderate PA-MSHA-related adverse events.ClinicalTrials.gov NCT01380808.

  19. Radiation myelitis after hypofractionated radiotherapy with concomitant gefitinib

    International Nuclear Information System (INIS)

    We describe the case of a 71-year-old Caucasian female with primary disseminated non-small cell cancer of the lung, presented for palliative radiotherapy of metastatic spread to the 9th and 11th thoracic vertebrae without intramedullary growth. Palliative radiotherapy with daily fractions of 3 Gy and a cumulative dose of 36 Gy to thoracic vertebrae 8-12 was performed. The patient received concomitantly 250 mg gefitinib daily. After a latent period of 16 months, the patient developed symptoms of myelitis. Magnetic resonance imaging (MRI) did not reveal any bony or intraspinal tumor progression, but spinal cord signal alteration. No response to steroids was achieved. The neurological symptoms were progressive in August 2013 with the right leg being completely plegic. The left leg was incompletely paralyzed. Deep and superficial sensitivity was also diminished bilaterally. The patient was completely urinary and anally incontinent. Contrary to the clinical findings, a follow-up MRI (July 2013) showed amelioration of the former signal alterations in the spinal cord. The diagnosis of paraneoplastic myelopathy was refuted by a negative test for autologous antibodies. At the last clinical visit in May 2014, the neurological symptoms were stable. The last tumor-specific treatment the patient is receiving is erlotinib 125 mg/d. We reviewed the literature and found no reported cases of radiation myelopathy after the treatment in such a setting. The calculated probability of such complication after radiotherapy alone is statistically measurable at the level of 0.02%. We suppose that gefitinib could also play a role in the development of this rare complication

  20. 卡培他滨联合多西他赛方案序贯卡培他滨维持治疗晚期乳腺癌疗效观察%Efficacy of Capecitabine Maintenance Therapy After Capecitabine plus Docetaxel in the Treatment of Advanced Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    张艳芳; 牛春莲; 张春珍; 夏金

    2015-01-01

    Objective To observe the efficacy and safety of capecitabine maintenance therapy after response to capecitabine plus docetaxel in the treatment of patients with advanced breast cancer. Methods Thirty-six patients with advanced breast cancer were enrolled and included in the analysis. All the patients received 4 to 6 cycles of capecitabine plus docetaxel regimen chemotherapy,the patients with disease control would been given single-agent capecitabine maintenance therapy. Results Of the 36 patients assessable for efficacy,the overall response rate was 44. 4%,and the disease control rate was 63. 9%. Twenty-three patients received capecitabine monotherapy as main-tenance therapy. The overall response rate was 47. 8%. The disease control rate was 69. 6%. The median progres-sion-free survival was 9. 5 months. 1-and 3-year survival rate was 72. 8% and 36. 4%,respectively. The main tox-icities were leukopenia,hypohepatia,hand-foot syndrome,skin pigmentation,oral mucositis which were moderate and manageable. Conclusion Capecitabine maintenance therapy after response to capecitabine plus docetaxel got the well curative effect in the treatment of patients with advanced breast cancer and was well tolerated,it would be con-sidered as a therapeutic salvage treatment regimen for advanced breast cancer.%目的:观察卡培他滨联合多西他赛方案治疗晚期乳腺癌获益之后以卡培他滨单药维持治疗的疗效和安全性。方法36例晚期乳腺癌患者给予卡培他滨联合多西他赛方案化疗4~6周期,疾病控制患者进入维持治疗,采用卡培他滨单药,评价疗效和毒副反应。结果全组36例患者中,总有效率为44.4%,疾病控制率为63.9%。23例进入维持组,有效率为47.8%,疾病控制率为69.6%,中位无进展生存时间为9.5个月。1、3 a生存率分别为72.8%、36.4%,主要毒副反应为白细胞减少、肝功能异常、手足综合征、皮肤色素沉着、口腔黏膜炎,多为轻度。

  1. Bevacizumab plus octreotide and metronomic capecitabine in patients with metastatic well-to-moderately differentiated neuroendocrine tumors: the xelbevoct study

    International Nuclear Information System (INIS)

    We assessed the activity and toxicity of the XELBEVOCT regimen in patients with metastatic well-to-moderately differentiated neuroendocrine neoplasms (WMD-NEN). Ancillary studies evaluated hypertension, proteinuria, and vascular endothelial growth factor (VEGF) polymorphisms in predicting progression-free survival (PFS) and the predictive role of serum vitamin D in progression-free survival and proteinuria onset. This prospective phase 2 study included 45 patients with WMD-NEN arising from various primary sites. The treatment regimen was octreotide long-acting release (LAR), 20 mg monthly, metronomic capecitabine, 2000 mg/daily, and intravenous bevacizumab, 5 mg/kg every 2 weeks, without interruption for 9 months. Bevacizumab was continued until disease progression. Partial response was obtained in 8 patients (17.8%, 95% confidence interval [CI], 6.4%-28.2%); tumor response was more frequent in pancreatic than in non-pancreatic malignancies. The median PFS was 14.9 months; median overall survival was not attained. Biochemical and symptomatic responses were observed in 52.9% and 82.3% of cases, respectively. The treatment was well tolerated. Grade 3 toxicities included hand and foot syndrome (11.1%), proteinuria (4.4%), and renal toxicity (2.2%). Proteinuria (all grades) was correlated with longer PFS (p = 0.017). There was an inverse relationship between proteinuria and vitamin D levels. VEGF polymorphisms were not associated with patient outcome. The XELBEVOCT regimen is active and well tolerated in patients with metastatic WMD-NEN. Proteinuria correlated with hypovitaminosis D status and was the best predictive factor of treatment efficacy. Trial registration number http://www.clinicaltrials.gov/ct2/show/NCT01203306?term

  2. Preoperative Chemoradiation for Rectal Cancer Using Capecitabine and Celecoxib Correlated With Posttreatment Assessment of Thymidylate Synthase and Thymidine Phosphorylase Expression

    International Nuclear Information System (INIS)

    Purpose: Thymidylate synthase (TS) and thymidine phosphorylase (TP) expression have been shown to be predictors of response to therapy. The toxicity, efficacy, surgical morbidity, and immunohistochemical TS and TP expression were assessed in surgical resection specimens after preoperative chemoradiation. Methods and Materials: Twenty patients with clinical stage I to III rectal adenocarcinoma received preoperative chemoradiation and underwent surgical resection 6 weeks later. Results: Posttreatment tumor stages were T1 to T2 and N0 in 30% of patients; T3 to T4 and N0 in 30% of patients; and T1 to T3 and N1 to N2 in 15% of patients. Pathologic complete response (pCR) was evident in 25% and tumor regression occurred in a total of 80% of patients. Anal sphincter-sparing surgery was performed in 80% of cases. Acute and perioperative complications were minimal, with no grade 3/4 toxicity or treatment breaks. Pelvic control was obtained in 90% of patients. With a median follow-up of 65.5 months (range, 8-80 months), the 6-year actuarial survival rate was 75%. Local failure was significantly associated with nonresponse to therapy and with high TS and low TP expression (p = 0.008 and p = 0.04, respectively). Conclusions: The combination of capecitabine, celecoxib, and x-radiation therapy yields excellent response: a 25% pathologic pCR, no acute grade 3/4 toxicity, and minimal surgical morbidity. Nonresponders expressed significantly increased TS levels and decreased TP levels in posttreatment resection specimens compared to responders.

  3. Dabigatran and rivaroxaban do not affect AA- and ADP-induced platelet aggregation in patients receiving concomitant platelet inhibitors.

    Science.gov (United States)

    Olivier, Christoph B; Weik, Patrick; Meyer, Melanie; Weber, Susanne; Diehl, Philipp; Bode, Christoph; Moser, Martin; Zhou, Qian

    2016-08-01

    Dabigatran and rivaroxaban are novel, vitamin K-independent oral anticoagulants (NOACs) and act via antagonism of the coagulation factor (F) IIa (dabigatran) or FXa (rivaroxaban), respectively. Compared to vitamin-K-antagonists, NOACs have shown non-inferiority of risk and benefit in patients with non valvular atrial fibrillation (AF). In clinical practice there is increasing use of NOACs combined with platelet inhibitors in patients with AF and coronary artery disease. However, whether NOACs affect the function of platelet inhibitors remains incompletely known. This observational study aimed to assess the platelet function in patients receiving dabigatran or rivaroxaban and concomitant platelet inhibitors. A single centre observational study was performed analysing the platelet aggregation of patients treated with dabigatran or rivaroxaban with or without concomitant platelet inhibitors. Measurements before the initiation of NOAC therapy served as the respective control group. Platelet aggregation was measured by multiple electrode aggregometry and was induced with adenosine diphosphate (ADP, 6.5 µM) and arachidonic acid (AA, 0.5 mM), respectively. In order to evaluate whether NOACs interact with platelet inhibition by ASA or the P2Y12-antagonist clopidogrel, 87 patients were grouped according to their concomitant antiplatelet medication. Comparing the ADP- and AA-induced platelet aggregation in patients without concomitant platelet inhibitors (n = 45) no significant differences under therapy with dabigatran (d) or rivaroxaban (r) compared to the control group (c) were observed. In patients taking clopidogrel as a concomitant platelet inhibitor (n = 21), neither dabigatran nor rivaroxaban affected the ADP-induced platelet aggregation (c 20 ± 11, d 21 ± 14, r 18 ± 8 AU*min, p = 0.200). Patients receiving dabigatran or rivaroxaban in combination with ASA (n = 42; 21 ASA only, 21 ASA + clopidogrel) showed no significant differences of the AA

  4. National Trends in Concomitant Psychotropic Medication with Stimulants in Pediatric Visits: Practice versus Knowledge

    Science.gov (United States)

    Bhatara, Vinod; Feil, Michael; Hoagwood, Kimberly; Vitiello, Benedetto; Zima, Bonnie

    2004-01-01

    Objectives: (1) To examine U.S. national trends in the use of concomitant pharmacotherapy with the stimulant class of psychotropic drugs in youth; and (2) to present these trends in the context of (a) extant safety and efficacy data, and (b) overall trends in concomitant pharmacotherapy with psychotropic drugs for youth. Methods: Prescribing data…

  5. Bayesian Inference for Concomitants based on Weibull Subfamily of Morgenstern Family Under Generalized Order Statistics

    Directory of Open Access Journals (Sweden)

    M.M. Mohie EL-Din

    2016-03-01

    Full Text Available In this paper, for Weibull subfamily of Morgenstern family, the joint density of the concomitants of generalized order statistics (GOS's is used to obtain the maximum likelihood estimates (MLE and Bayes estimates for the distribution parameters. Applications of these results for concomitants of order statistics are presented.

  6. Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; Thomas, L.; Alings, M.; Atar, D.; Aylward, P.; Goto, S.; Hanna, M.; Huber, K.; Husted, S.; Lewis, B.S.; McMurray, J.J.; Pais, P.; Pouleur, H.; Steg, P.G.; Verheugt, F.W.A.; Wojdyla, D.M.; Granger, C.B.; Wallentin, L.

    2014-01-01

    AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was le

  7. Effect comparison of different chemotherapy regimens of capecitabine in breast cancer liver metastasis%卡培他滨不同化疗方案治疗乳腺癌肝转移的效果对比

    Institute of Scientific and Technical Information of China (English)

    吴庆成

    2015-01-01

    目的:比较卡培他滨+多西他赛、卡培他滨+长春瑞滨治疗乳腺癌肝转移的疗效及安全性。方法以本院2012年1月~2014年12月收治的50例乳腺癌肝转移患者为研究对象,根据不同化疗方案将其分为A、B组。A组采取卡培他滨+多西他赛治疗,B组给予卡培他滨+长春瑞滨治疗,比较两组临床疗效及不良反应发生情况。结果 A组治疗有效率、不良反应发生率分别为72.0%、24.0%,与B组的68.0%、32.0%比较,差异无统计学意义(P>0.05)。结论卡培他滨+多西他赛、卡培他滨+长春瑞滨治疗乳腺癌肝转移的效果及不良反应无明显差异,但临床建议优先选择卡培他滨+多西他赛化疗方案。%Objective To compare the efficacy and safety of capecitabine with docetaxel and capecitabine with vinorel-bine in the treatment of breast cancer liver metastasis. Methods 50 patients with breast cancer liver metastasis from January 2012 to December 2014 in our hospital were selected as research objects,according to different chemotherapy regimens were divided into group A and group B.Capecitabine with docetaxel was used in group A,capecitabine with vinorelbine was applied in group B.The clinical curative effect and adverse reaction between the two groups was com-pared. Results The total effective rate and incidence of adverse reactions in group A was 72.0% and 24.0% respec-tively,while in group B,that was 68.0% and 32.0% in turn,the difference was not significant (P>0.05). Conclusion There is no significant difference in curative effect or adverse reaction by capecitabine with docetaxel or capecitabine with vinorelbine in treating breast cancer liver metastasis,but the chemotherapy regimen of capecitabine with docetaxel is preferred by physician’s suggestion in clinic.

  8. Clinical outcomes of HER2-positive metastatic breast cancer patients with brain metastasis treated with lapatinib and capecitabine: an open-label expanded access study in Korea

    Directory of Open Access Journals (Sweden)

    Ro Jungsil

    2012-07-01

    Full Text Available Abstract Background To evaluate efficacy in patients with brain metastasis (BM on entry into the lapatinib expanded access program (LEAP. Methods LEAP is a worldwide, single-arm, open-label study. HER2-positive, locally-advanced or metastatic breast cancer patients with progression after an anthracycline, taxane, and trastuzumab were eligible. Patients received capecitabine 2000 mg/m2 daily in two divided doses, days 1–14, every 21 days and lapatinib 1250 mg once daily. Results Among 186 patients enrolled in 6 Korean centers, 58 had BM. Progression-free survival (PFS was 18.7 weeks in patients with BM and 19.4 weeks without BM (P = 0.88. In patients with BM, brain response was synchronized with systemic responses (P = 0.0001. Overall survival (OS was 48.9 weeks in patients with BM and 64.6 weeks without BM (P = 0.23. Multivariable analysis found hormone receptor positivity (P = 0.003 and clinical benefit rate (CBR of combined systemic and brain disease (P  Conclusion Lapatinib plus capecitabine is equally effective in patients with or without BM. Trial registration ClinicalTrials.gov (NCT00338247

  9. Adverse Event Profiles of 5-Fluorouracil and Capecitabine: Data Mining of the Public Version of the FDA Adverse Event Reporting System, AERS, and Reproducibility of Clinical Observations

    Directory of Open Access Journals (Sweden)

    Kaori Kadoyama, Ikuya Miki, Takao Tamura, JB Brown, Toshiyuki Sakaeda, Yasushi Okuno

    2012-01-01

    Full Text Available Objective: The safety profiles of oral fluoropyrimidines were compared with 5-fluorouracil (5-FU using adverse event reports (AERs submitted to the Adverse Event Reporting System, AERS, of the US Food and Drug Administration (FDA.Methods: After a revision of arbitrary drug names and the deletion of duplicated submissions, AERs involving 5-FU and oral fluoropyrimidines were analyzed. Standardized official pharmacovigilance tools were used for the quantitative detection of signals, i.e., drug-associated adverse events, including the proportional reporting ratio, the reporting odds ratio, the information component given by a Bayesian confidence propagation neural network, and the empirical Bayes geometric mean.Results: Based on 22,017,956 co-occurrences, i.e., drug-adverse event pairs, found in 1,644,220 AERs from 2004 to 2009, it was suggested that leukopenia, neutropenia, and thrombocytopenia were more frequently accompanied by the use of 5-FU than capecitabine, whereas diarrhea, nausea, vomiting, and hand-foot syndrome were more frequently associated with capecitabine. The total number of co-occurrences was not large enough to compare tegafur, tegafur-uracil (UFT, tegafur-gimeracil-oteracil potassium (S-1, or doxifluridine to 5-FU.Conclusion: The results obtained herein were consistent with clinical observations, suggesting the usefulness of the FDA's AERS database and data mining methods used, but the number of co-occurrences is an important factor in signal detection.

  10. Temozolomide (Temodar®) and capecitabine (Xeloda®) treatment of an aggressive corticotroph pituitary tumor

    OpenAIRE

    Thearle, Marie S.; Freda, Pamela U.; Bruce, Jeffrey N.; Isaacson, Steven R.; Lee, Yoomi; Fine, Robert L.

    2011-01-01

    Only rarely do corticotroph pituitary tumors become invasive leading to symptoms caused by compression of cranial nerves and other local structures. When aggressive pituitary neuroendocrine tumors do develop, conventional treatment options are of limited success. A 50-year-old man developed a giant invasive corticotroph pituitary tumor 2 years after initial presentation. His tumor and symptoms failed to respond to maximal surgical, radio-surgical, radiation and medical therapy and a bilateral...

  11. Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage II and III rectal cancer

    International Nuclear Information System (INIS)

    Objective: To compare the acute toxicities between two prospective, non-randomize phase II trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage II and III rectal cancer. Methods: From March 2005 to November 2007, based on two fulfilled phase I studies, two phase II trials were launched respectively to further observe the tolerance and toxicity. In one trial, 118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio- therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d (d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin,capecitabine and radiotherapy(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2 (d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results: There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, χ2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, χ2=4.80, P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia, diarrhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in GI, including nausea (68.9% vs 22.0%, χ2=46.90, P= 0.000), diarrhea (76.7% vs 57.6%, χ2=13.50, P=0.009), fatigue (47.8% vs 13.7%, χ2=18.90, P=0.000), hand-foot syndrome (14.4% vs 4.2%, χ2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, χ2=25.70,P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytopenia. Of all the patients, grade 3 and grade 4 toxicities were diarrhea (24.0% and 1.0%), leukopenia(4.3% and 0.0% ), radiation-induced dermatitis (3.8% and 0.0%), cramping abdominal pain (1.0% and 0.0%) and fatigue(0.5% and 0.0% ). Only grade 3 and 4 diarrhea was significantly more in Cap

  12. Is drug discontinuation risk of adalimumab compared with etanercept affected by concomitant methotrexate dose in patients with rheumatoid arthritis?

    Directory of Open Access Journals (Sweden)

    Chen HH

    2016-02-01

    Full Text Available Hsin-Hua Chen,1–6 Der-Yuan Chen,1–3,6–8 Yi-Ming Chen,1–3 Chao-Hsiun Tang9 1Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; 3Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; 4Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taiwan, Republic of China; 5Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, Republic of China; 6School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, Republic of China; 7Institute of Biomedical Science, Chung-Hsing University, Taichung, Taiwan, Republic of China; 8Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; 9School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, Republic of China Objective: To compare drug discontinuation risk between adalimumab (ADA and etanercept (ETN treatment among anti-tumor necrosis factor (anti-TNF-naïve rheumatoid arthritis (RA patients, in particular the influence of concomitant dose of methotrexate (MTX.Methods: This retrospective nationwide population-based cohort study identified 4,592 anti-TNF-naïve RA patients in whom ETN (n=2,609 or ADA (n=1,983 was initiated using National Health Insurance claims data. After adjustment for prior medication, concomitant medication, and baseline demographic data, the relative risk of drug discontinuation in ADA users compared with ETN users was quantified by calculating adjusted hazard ratios (aHRs with 95% confidence intervals (CIs using Cox proportional hazard regression analyses, stratified by the follow-up time (≤1 year, >1 year and/or concomitant MTX dose (≤10 mg/wk, >10 mg/wk.Results: ADA users

  13. Concomitant use of corticosteroid and antimicrobials for liver abscesses in patients with chronic granulomatous disease.

    Science.gov (United States)

    Shin, Kyung-Sue; Lee, Mu Suk

    2016-04-01

    Chronic granulomatous disease (CGD) is a rare inherited disorder caused by defective nicotinamide adenine dinucleotide phosphate oxidase enzyme and characterized by recurrent bacterial and fungal infections. Although liver abscess is a common manifestation of CGD, its management in CGD patients is not well-defined. In addition, the generalized guidelines for treating liver abscesses do not necessarily apply to CGD patients. Corticosteroids are commonly used to control granulomatous complications, such as inflammatory gastrointestinal and genitourinary lesions, in patients with CGD, Corticosteroids have also been used in combination with antimicrobials to treat refractory infections in patients with CGD. Because corticosteroids are capable of suppressing symptomatic inflammation, all potential infections must be adequately controlled prior to corticosteroid initiation. We report 3 typical CGD cases with liver abscesses refractory to conventional treatments that were successfully treated with the concomitant use of corticosteroid and antimicrobials. It remains unclear whether corticosteroid therapy is required for liver abscesses in CGD refractory to conventional treatments. However, based on our observations, use of corticosteroids in combination with optimal antimicrobials should be considered for refractory liver abscesses in CGD. PMID:27186231

  14. Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections

    Directory of Open Access Journals (Sweden)

    Erin Burnett

    2015-01-01

    Full Text Available Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB, postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR 2.11, 95% confidence interval [CI] 1.12–3.97. After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78. Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.

  15. Pharmacokinetics and Pulmonary Distribution of Clarithromycin and Rifampicin after Concomitant and Consecutive Administration in Foals.

    Science.gov (United States)

    Berlin, Sarah; Spieckermann, Lena; Oswald, Stefan; Keiser, Markus; Lumpe, Stefan; Ullrich, Anett; Grube, Markus; Hasan, Mahmoud; Venner, Monica; Siegmund, Werner

    2016-03-01

    Drug interactions often result from multiple pharmacokinetic changes, such as after rifampicin (RIF) and clarithromycin (CLA) in the treatment of abscessing lung diseases. Comedication of RIF may interact with CLA disposition by either induction of presystemic elimination processes and/or inhibition of uptake mechanisms because it regulates gene transcription and modulates function of various CYP enzymes, multidrug efflux and uptake transporters for which CLA is a substrate. To distinguish the transcriptional changes from the modulating interaction components upon CLA absorption and pulmonary distribution, we initiated a repeated-dose study in 12 healthy foals with CLA (7.5 mg/kg, p.o., b.i.d.) in comedication with RIF (10 mg/kg, p.o., b.i.d.) given either concomitantly with CLA or consecutively 4 h after CLA. Affinity of CLA to human P-gp, MRP2, and MRP3 and to OCT1, OCT3, and PEPT1 was measured using Sf9-derived inside-out membrane vesicles and transfected HEK293 cells, respectively. ABCB1 (P-gp) induction by RIF and affinity of CLA to equine P-gp were studied using primary equine hepatocytes. Absolute bioavailability of CLA was reduced from ∼40% to below 5% after comedication of RIF in both schedules of administration, and Tmax occurred ∼2-3 h earlier. The loss of bioavailability was not associated with increased 14-hydroxyclarithromycin (14-OH-CLA) exposure. After consecutive dosing, absolute bioavailability and pulmonary penetration of CLA increased ∼2-fold compared to concomitant use. In vitro, CLA showed affinity to human and equine P-gp. Expression of ABCB1 mRNA was upregulated by RIF in 7 of 8 duodenal biopsy specimens and in primary equine hepatocytes. In conclusion, the major undesired influence of RIF on oral absorption and pulmonary distribution of CLA is associated with induction of intestinal P-gp. Consecutive administration to avoid competition with its intestinal uptake transport results in significantly, although not clinically relevant

  16. Clinical observation of capecitabine maintenance therapy after response to capecitabine -based combination chemotherapy in patients with metastatic breast cancer%含卡培他滨联合方案一线化疗后卡培他滨维持治疗转移性乳腺癌临床观察

    Institute of Scientific and Technical Information of China (English)

    童刚领; 王芬; 陈晓秋; 彭安; 申东兰; 王树滨

    2014-01-01

    Objective:To investigate the curative effect and toxicity of capecitabine maintenance chemotherapy af-ter the first-line capecitabine-based combination chemotherapy for patients with metastatic breast cancer(MBC). Methods:This study enrolled into 20 chemotherapy-naive MBC patients.They received 6 cyceles of docetaxel/gem-citabine/vinorelbine and capecitabine chemotherapy,and patients who responded to the themotherapy were assigned to capecitabine maintenance chemotherapy until disease progression or intolerable toxicity.Results:Patients were evalua-ted for the first-line therapy efficacy.The patients who acquired CR,PR and SD were 1,7 and 12.The median of ten cycles of the capecitabine maintenance chemotherapy were completed in 20 patients.The median progression free sur-vival time was 12.2 months.The median time to progression was 7.7 months.The median overall survival time was 20.2 months.The most common toxicity included hand -foot syndrome,myelosuppression,diarrhea.Conclusion:Capecitabine maintenance chemotherapy is benefit in survival in MBC patients,and with low toxicity.%目的:探讨转移性乳腺癌含卡培他滨联合方案一线化疗后继续卡培他滨维持化疗的疗效和毒副反应。方法:入组20例转移性乳腺癌患者,一线采用多西他赛/吉西他滨/长春瑞滨联合卡培他滨化疗6个周期,疗效评价无进展的患者采用卡培他滨维持化疗持续到疾病进展或出现不能耐受毒副反应为止。结果:一线治疗CR 1例,PR 7例,SD 12例,卡培他滨平均维持化疗周期为10个周期。中位PFS为12.2个月,中位TTP为7.7个月,中位OS为20.2个月。主要毒副反应为手足综合征、骨髓抑制、腹泻等,均可控制。结论:卡培他滨可作为转移性乳腺癌的维持治疗,可改善患者生存,毒副反应轻。

  17. [Brown urine : Myoglobin-induced renal failure after concomitant administration of simvastatin and amiodarone].

    Science.gov (United States)

    Pietsch, U; Müller-Höcker, C; Filipovic, M

    2016-05-01

    Rhabdomyolysis is a rare but well-known complication of statin therapy. The risk is considerably increased when concomitant drugs are administered that inhibit metabolism and breakdown via the cytochrome CYP3A4. We report a case of myoglobin-induced acute renal failure secondary to the concomitant use of simvastatin and amiodarone. The risk of rhabdomyolysis is mainly determined by the statin dose; in the case of the concomitant use of CYP3A4 inhibitors, a maximal daily dose of 20 mg is recommended to avoid harmful drug interactions. PMID:27142363

  18. Intradural tumor and concomitant disc herniation of cervical spine

    Directory of Open Access Journals (Sweden)

    Mihir R Bapat

    2011-01-01

    Full Text Available We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

  19. CAPIRI-IMRT: a phase II study of concurrent capecitabine and irinotecan with intensity-modulated radiation therapy for the treatment of recurrent rectal cancer

    International Nuclear Information System (INIS)

    This study investigated the local effect and acute toxicity of irinotecan and capecitabine with concurrent intensity-modulated radiation therapy (IMRT) for the treatment of recurrent rectal cancer without prior pelvic irradiation. Seventy-one patients diagnosed with recurrent rectal cancer who did not previously receive pelvic irradiation were treated in our hospital from October 2009 to July 2012. Radiotherapy was delivered to the pelvis, and IMRT of 45 Gy (1.8 Gy per fraction), followed by a boost of 10 Gy to 16 Gy (2 Gy per fraction), was delivered to the recurrent sites. The concurrent chemotherapy regimen was 50 mg/m2 irinotecan weekly and 625 mg/m2 capecitabine twice daily (Mon-Fri). Radical surgery was recommended for medically fit patients without extra-pelvic metastases. The patients were followed up every 3 months. Tumor response was evaluated using CT/MRIs according to the RECIST criteria or postoperative pathological findings. NCI-CTC 3.0 was used to score the toxicities. Forty-eight patients (67.6%) had confirmed recurrent rectal cancer without extra pelvic metastases, and 23 patients (32.4%) had extra pelvic metastases. Fourteen patients (19.7%) underwent radical resections (R0) post-chemoradiation. A pathologic complete response was observed in 7 of 14 patients. A clinical complete response was observed in 4 patients (5.6%), and a partial response was observed in 22 patients (31.0%). Only 5 patients (7.0%) showed progressive disease during or shortly after treatment. Of 53 symptomatic patients, clinical complete and partial symptom relief with chemoradiation was achieved in 56.6% and 32.1% of patients, respectively. Only 2 patients (2.8%) experienced grade 4 leukopenia. The most common grade 3 toxicity was diarrhea (16 [22.5%] patients). The median follow-up was 31 months. The cumulative local progression-free survival rate was 74.2% and 33.9% at 1 and 3 years after chemoradiation, respectively. The cumulative total survival rate was 80.1% and 36

  20. Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern

    International Nuclear Information System (INIS)

    In children, septic arthritis (SA) of the hip is either primary or concomitant with acute haematogenous osteomyelitis (AHO). However, seldom, patients with isolated SA at presentation, may later show osteomyelitis in the metaphysis. The aim of this study was to elaborate a physiopathological hypothesis based on the peculiar MRI findings to explain the onset of AHO after SA. Cases of acute infection of the hip admitted between January 2010 and December 2013 were retrospectively reviewed to assess radiographic and MRI features, as well as bacteriological findings. Only children with isolated SA were included in this study, whereas cases of concomitant SA and AHO at presentation were excluded. Ten patients met the inclusion criteria. Six (1–11 months) demonstrated, on the initial MRI, decreased perfusion on gadolinium enhanced fat-suppressed T1-weighted sequence of the femoral epiphysis and developed one month later metaphyseal AHO. Four (5–14 years) did not show decreased perfusion and did not develop AHO on follow-up. The type of germ involved influenced neither the type of enhancement pattern nor the outcome. Age under one year and decreased perfusion of the affected femoral epiphysis increases the risk of secondary AHO. Our study is the first report in human medicine supporting the physiopathological hypothesis described by Alderson et al. in an animal model: primary infection can originally affect the joint, then penetrate the epiphyseal cartilage, and finally spread into the metaphyseal region through transphyseal vessels present only in the first 12/18 months of life

  1. Concomitant biohydrogen and poly-β-hydroxybutyrate production from dark fermentation effluents by adapted Rhodobacter sphaeroides and mixed photofermentative cultures.

    Science.gov (United States)

    Ghimire, Anish; Valentino, Serena; Frunzo, Luigi; Pirozzi, Francesco; Lens, Piet N L; Esposito, Giovanni

    2016-10-01

    This work aimed at investigating concomitant production of biohydrogen and poly-β-hydroxybutyrate (PHB) by photofermentation (PF) using dark fermentation effluents (DFE). An adapted culture of Rhodobacter sphaeroides AV1b (pH 6.5, 24±2°C) achieved H2 and PHB yields of 256 (±2) NmLH2/g Chemical Oxygen Demand (COD) and 273.8mgPHB/gCOD (32.5±3% of the dry cells weight (DCW)), respectively. When a diluted (1:2) DFE medium was applied to the adapted pure and mixed photofermentative culture, the respective H2 yields were 164.0 (±12) and 71.3 (±6) NmLH2/gCOD and the PHB yields were 212.1 (±105.2) and 50.7 (±2.7) mgPHB/gCOD added, corresponding to 24 (±0.7) and 6.3 (±0) % DCW, respectively. The concomitant H2 and PHB production from the PF process gave a good DFE post treatment achieving up to 80% COD removal from the initial DFE. PMID:27005789

  2. Multicenter study of radiosynoviorthesis. Clinical outcome in osteoarthritis and other disorders with concomitant synovitis in comparison with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Aim: evaluation of the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. Patients, methods: 803 RSO treatments were monitored in 691 patients by standardized questionnaires of 7 centers in 3 countries. Patients were assigned to 3 groups according to their age (20-40, 41-60, 61-80 years). Additionally, the data were analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis or persistent effusions after joint replacement (group B). Results: ameliorations of joint pain, swelling/effusion or flexibility were found in 80% of group A and 56% of group B (p <0.01). Quality of life improved in 78% of group A and 59% of group B (p <0.01). The response rate was similar for small- and large-sized joints in group A, but significantly higher for large-sized joints in group B (p <0.01). The positive effects on joint pain, swelling/effusion or flexibility lasted longer in group A (p <0.01). Repeated RSOs were as effective as initial ones. The clinical outcome was neither influenced by age, nor gender, nor transient immobilisation for 48 hours after RSO. Conclusion: although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis. (orig.)

  3. A clinical study of thrombectomy and interventional treatment of iliac vein stenosis concomitant with thrombosis

    International Nuclear Information System (INIS)

    Objective: To study the effect of thrombectomy and interventional treatment of iliac vein stenosis concomitant with thrombosis. Methods: We adopt filter placing, thrombectomy, provistionality artery vein fistula and implanted stents and balloon-expansion to treat patients. Results: Symptoms disappeared in 18 patients, were significantly improved in 3 patients. Conclusion: The effect of thrombectomy and interventional treatmen of iliac vein stenosis concomitant with thrombosis is safe and satisfactory. (authors)

  4. Association between filaggrin null mutations and concomitant atopic dermatitis and contact allergy

    DEFF Research Database (Denmark)

    Carlsen, B C; Thyssen, J P; Menné, T;

    2011-01-01

    The phenotypic traits of people with the filaggrin mutation (FLG) genotype and atopic dermatitis (AD) are still under elucidation, and the association with concomitant AD and contact allergy (CA) has not previously been examined.......The phenotypic traits of people with the filaggrin mutation (FLG) genotype and atopic dermatitis (AD) are still under elucidation, and the association with concomitant AD and contact allergy (CA) has not previously been examined....

  5. EGF61A>G polymorphism as predictive marker of clinical outcome to first-line capecitabine and oxaliplatin in metastatic colorectal cancer

    DEFF Research Database (Denmark)

    Spindler, Karen-Lise Garm; Andersen, R F; Jensen, L H; Ploen, J; Jakobsen, Anders

    2010-01-01

    BACKGROUND: The purpose of the present study was to investigate polymorphisms related to the metabolism of fluoropyrimidine and oxaliplatin, thymidylate synthase (TS) and excision repair cross-complementing gene 1 (ERCC1) 118, in metastatic colorectal cancer patients treated with capecitabine and...... oxaliplatin (XELOX). We also investigated the importance of the EGF61A>G polymorphism, which holds a functional influence on the tyrosine kinase receptor regulation. Materials and methods: We included 68 patients treated with first-line XELOX. Polymorphism analyses were carried out on pretreatment blood...... samples. Response was evaluated according to the RECIST. Survival analysis was described by the Kaplan-Meier method and log-rank testing. RESULTS: The overall response rate was 38% and the median overall survival 19.4 months. A favorable outcome was seen in patients with the EGF61A/G genotype compared...

  6. Four-Week Neoadjuvant Intensity-Modulated Radiation Therapy With Concurrent Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer Patients: A Validation Phase II Trial

    International Nuclear Information System (INIS)

    Purpose: To validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer. Methods and Materials: Patients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m2 b.i.d., Monday to Friday) and oxaliplatin (60 mg/m2 on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed. Results: A total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9% of the patients. Grade 3 proctitis in 18% of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4% thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13% of the patients, major response (96–100% of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97% of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively. Conclusions: Preoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible and safe, and produces major pathological responses in approximately 50% of patients.

  7. A novel schedule of erlotinib/capecitabine (7/7) as salvage therapy in previously treated advanced pancreatic adenocarcinoma: a case series

    Science.gov (United States)

    Chen, Jiezhong; Kaley, Kristin; Garcon, Marie Carmel; Rodriguez, Teresa; Saif, Muhammad Wasif

    2016-01-01

    Background: The objective of this study was to report a case series on the efficacy and safety of capecitabine 7/7 schedule combined with erlotinib (CAP-ERL) in patients with advanced pancreatic cancer (APC) who have failed prior therapies. Methods: We retrospectively evaluated 13 patients with locally advanced or metastatic pancreatic cancer previously treated with gemcitabine or oxaliplatin–irinotecan-based first-line regimens. Treatment consisted of capecitabine (Xeloda) at a flat dose of 1000 mg orally twice daily on days 1–7 out of 14 days (7/7 schedule) and erlotinib (Tarceva) 100 mg orally once daily until unacceptable toxicity or disease progression. Tumor assessments were repeated every two cycles (8 weeks) and serum tumor markers were measured every 4 weeks. Results: All patients (median age: 63 years; 7 female/3 male) had various previous lines of treatments of chemotherapies. Median number of cycles with CAP-ERL was 4 (range 2–12). The overall response rate was 20%. CA19-9 was reduced more than 25% in 40% patients. The median overall survival and progression-free survival from the start of CAP-ERL were 4.5 months (range 3–7.5) and 2 months (range 1.5–4), respectively. The most common grade 3 toxicities included hand–foot syndrome, nausea, vomiting, diarrhea, rash, and fatigue. Conclusions: Our result suggests that the combination of a fixed low dose of CAP-ERL 7/7 schedule was tolerated with manageable toxicity and showed encouraging activity as salvage treatment in patients with refractory APC with ECOG performance status 0–2. Further prospective studies are warranted to evaluate this combination. PMID:26929778

  8. Four-Week Neoadjuvant Intensity-Modulated Radiation Therapy With Concurrent Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer Patients: A Validation Phase II Trial

    Energy Technology Data Exchange (ETDEWEB)

    Arbea, Leire, E-mail: larbea@unav.es [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Martinez-Monge, Rafael; Diaz-Gonzalez, Juan A.; Moreno, Marta; Rodriguez, Javier [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Hernandez, Jose Luis [Department of General Surgery, Clinica Universidad de Navarra, Navarra (Spain); Sola, Jesus Javier [Department of Pathology, Clinica Universidad de Navarra, Navarra (Spain); Ramos, Luis Isaac [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Subtil, Jose Carlos [Department of Gastroenterology, Clinica Universidad de Navarra, Navarra (Spain); Nunez, Jorge [Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Navarra (Spain); Chopitea, Ana; Cambeiro, Mauricio; Gaztanaga, Miren; Garcia-Foncillas, Jesus; Aristu, Javier [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain)

    2012-06-01

    Purpose: To validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer. Methods and Materials: Patients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m{sup 2} b.i.d., Monday to Friday) and oxaliplatin (60 mg/m{sup 2} on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed. Results: A total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9% of the patients. Grade 3 proctitis in 18% of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4% thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13% of the patients, major response (96-100% of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97% of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively. Conclusions: Preoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible and safe, and produces major pathological responses in approximately 50% of patients.

  9. Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved

  10. Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Esnaola, Nestor F. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Chaudhary, Uzair B.; O' Brien, Paul [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Garrett-Mayer, Elizabeth [Division of Biostatistics and Epidemiology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Camp, E. Ramsay [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Thomas, Melanie B. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Cole, David J. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Montero, Alberto J. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Hoffman, Brenda J.; Romagnuolo, Joseph [Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Orwat, Kelly P. [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Marshall, David T., E-mail: marshadt@musc.edu [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.

  11. Concomitant Pancreas Divisum and Double Pylorus: A Case Report

    Directory of Open Access Journals (Sweden)

    Gurhan Sisman

    2014-11-01

    Full Text Available Double pylorus (DP is a rare condition that is usually discovered incidentally through an upper endoscopy (UE examination. While acquired DP, which is the most common type, often develops as a complication of peptic ulcer disease (PUD, congenital DP can be isolated associated with other congenital abnormalities such as heterotopic pancreatic tissue or gastric duplication [1, 2]. This article presents the first case of DP associated with pancreas divisum (PD. A twenty two-year-old woman was admitted to our hospital because of mild epigastric pain. Her medical history was unremarkable. The laboratory tests that were requested on admission were normal except for amylase 920 U/L (reference range: 60-180 U/L.The patient denied having had any history of PUD or of having used nonsteroidal anti-inflammatory drugs (NSAIDs. A UE examination revealed two pyloric openings into the duodenal bulb. However, there was no evidence of PUD on the UE. The presence of Helicobacter pylori was not observed in the histologic examination of the gastric antrum tissue. Magnetic resonance cholangiopancreatogram (MRCP imaging showed PD (Figure 1 A-B. The patient was treated symptomatically, and she recovered. When the UE and MRCP were repeated for control on the sixth month of the treatment, they demonstrated the same findings as the initial UE and MRCP.

  12. Reduced Anticoagulant Effect of Dabigatran in a Patient Receiving Concomitant Phenytoin.

    Science.gov (United States)

    Wiggins, Barbara S; Northup, Amanda; Johnson, Dominic; Senfield, Jeffrey

    2016-02-01

    Dabigatran, a direct thrombin inhibitor, is an oral anticoagulant indicated for the prevention of stroke in patients with atrial fibrillation (AF) and for the treatment and prevention of deep vein thrombosis and pulmonary embolism. Dabigatran, as well as the other new anticoagulants-rivaroxaban, apixaban, and edoxaban-are substrates for P-glycoprotein (P-gp). Although the U.S. labeling for rivaroxaban and apixaban states to avoid concomitant use with phenytoin, a known P-gp inducer, the U.S. labeling for dabigatran and edoxaban are less clear. We describe the first case report, to our knowledge, documenting a drug interaction between phenytoin and dabigatran by using laboratory measurements of dabigatran serum concentrations. A 45-year-old African-American man was admitted to the inpatient cardiology service following defibrillations from his implantable cardioverter defibrillator. The patient was evaluated and received appropriate antitachycardia pacing for atrial tachyarrhythmias for an episode of ventricular tachycardia (VT), and antiarrhythmic therapy with sotalol was initiated to reduce both his AF and VT burden. On review of the patient's medications for potential interactions, it was discovered that the patient was taking both dabigatran and phenytoin. To determine the magnitude of this drug interaction prior to making a change in his anticoagulation regimen, a dabigatran serum concentration was measured. This concentration was undetectable, indicating that phenytoin had a significant influence on dabigatran's metabolism and that this patient was at high risk for stroke. Clinicians should be aware of this interaction between phenytoin and dabigatran as well as with all other new oral anticoagulants. In patients taking phenytoin who require an anticoagulant, only warfarin should be prescribed to minimize the risk of stroke. In addition, the prescribing information for dabigatran should be updated to include other medications that result in a significant

  13. 卡培他滨联合奥曲肽对人乳腺癌细胞MCF-7增殖的影响%Effects of capecitabine combined with octreotide on proliferation of human breast cancer cell MCF-7

    Institute of Scientific and Technical Information of China (English)

    张家铭; 颜家琪; 江学庆

    2015-01-01

    Objective To study the effect of capecitabine combined with octreotide on proliferation cycle of breast cancer MCF-7 cells.Methods The experiments were divided into 4 groups:control group,capecitabine group,octreotide group,combined group (capecitabine plus octreotide),and subgroups of each group were set up according to the concentrations.Cell proliferation was measured by methyl thiazol tetrazolium (MTT) assay.Results Combined use of capecitaine and octreotide in high concentrations could inhibited the proliferation of MCF-7 cells.The MCF cells grew faster within 4 days,then gradually slowed down,and 9 days later cell growth tended to stagnate.Capecitaine and octreotide in high concentrations showed a synergistic effect.Conclusion Capecitabine combined with octreotide can inhibit the proliferation of MCF-7 cells.%目的 观察卡培他滨联合奥曲肽对乳腺癌MCF-7细胞增殖周期的影响.方法 实验分为4组:对照组、卡培他滨组、奥曲肽组、联合组(卡培他滨+奥曲肽).每组分为不同浓度,以MTT法检测细胞增殖状况.结果 卡培他滨与奥曲肽在较高浓度水平联用抑制MCF-7细胞增殖,MCF细胞生长初期(4d内)生长速度较快,滞后逐渐减慢,9d后细胞生长趋于停滞;在高浓度水平联用抑制MCF-7细胞生长,表现为协同作用.结论 卡培他滨联合奥曲肽对MCF-7细胞增殖具有抑制作用.

  14. The impact of concomitant rhinitis on asthma-related quality of life and asthma control.

    OpenAIRE

    Vandenplas, O.; Dramaix, M.; Joos, G; Louis, Renaud; Michils, A; Verleden, G.; Vincken, W; Vints, A. M.; Herbots, E.; Bachert, C

    2010-01-01

    To cite this article: Vandenplas O, Dramaix M, Joos G, Louis R, Michils A, Verleden G, Vincken W, Vints A-M, Herbots E, Bachert C. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy 2010; DOI: 10.1111/j.1398-9995.2010.02365.x. Abstract Background: Characterizing the interactions between the upper and lower airways is important for the management of asthma. This study aimed at assessing the specific impact of concomitant rhinitis on asthma-related ...

  15. Oxidized limonene and oxidized linalool - Concomitant contact allergy to common fragrance terpenes

    DEFF Research Database (Denmark)

    Bråred Christensson, Johanna; Karlberg, Ann Therese; Andersen, Klaus E.;

    2016-01-01

    Summary Background Limonene and linalool are common fragrance terpenes. Both oxidized R-limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively. Objective To investigate concomitant...... of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance...

  16. Is concomitant quadruple therapy for Helicobacter pylori eradication really needed for Japanese patients?

    Institute of Scientific and Technical Information of China (English)

    Vincenzo; De; Francesco; Angelo; Zullo; Cesare; Hassan

    2012-01-01

    The study found that the 7 d of concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) achieved significantly higher eradication rates compared to 7 d of triple therapy (lansoprazole, amoxicillin, clarithromycin), the intention to treat (ITT) cure rates being 94.9% and 68.3%, respectively. According to our opinion, this study is clinically relevant for Japanese physicians for at least 2 reasons: (1) the standard triple therapy (clarithromycin plus amoxicillin) achieved disappointing cure rates in Japan-in agreement with what was observed in several countries; and (2) the concomitant quadruple therapy is an effective therapeutic alternative.

  17. [FUNCTIONAL STATE OF STATOKINETIC SYSTEM AND CERVICAL SPINE IN EDENTULOUS PATIENTS WITH CONCOMITANT SOMATIC PATHOLOGY].

    Science.gov (United States)

    Ovsiannikov, K A; Veretenko, E A; Iordanishvili, A K

    2015-01-01

    This study was aimed to evaluate the functional state of statokinetic system and cervical spine in edentulous patients with concomitant somatic pathology before and three months after prosthetic dental treatment. Thirty seven edentulous patients underwent comprehensive examination including computer-assisted stabilometry. Stabilometric recordings were performed using stabilometric platform "Stabilan-01" (manufactured by special design office "Ritm", Taganrog) by means of special tests. According to the data of computer-assisted stabilometry prosthetic dental treatment leads to improvement of the functional state of statokinetic system and cervical spine in patients with concomitant somatic pathology. PMID:26390624

  18. Concomitant boost radiation therapy for inoperable non-small-cell lung cancer: preliminary report of a prospective randomized study

    International Nuclear Information System (INIS)

    Purpose: The radiation therapy results for patients with inoperable non-small-cell lung cancer (NSCLC) have been disappointing. Tumor dose escalation using concomitant boost technique (CBT) has been shown to improve local control in a few prospective studies. This trial was carried out to prospectively assess the radiation response and acute toxicity of CBT in comparison to the conventional treatment technique (CTT). Methods and Materials: Ninety-seven consecutive eligible patients were entered in this prospective clinical trial between November 1994 and February 1998. Patients were randomized to receive either CBT (43 patients) or CTT (54 patients) radiation therapy. These patients either refused chemotherapy or were judged as unsuitable for chemotherapy. Patients in the CBT group received 46.8 Gy in 26 fractions using large fields that encompassed the gross and occult disease. A concomitant boost of 18.2 Gy (0.7 Gy per fraction) was delivered to the gross disease using small fields with 1.5-cm margins. The small fields were treated concurrently with the large fields and the total dose to the tumor area was 65 Gy in 26 fractions. Patients in the CTT group received 70.8 Gy in 38 fractions. The acute toxicity between each group was compared. The response rate was analyzed and compared by treatment group, gender, age, stage, histology, initial Karnofsky performance score (KPS), severity of acute toxicity, and maximum body weight loss (MBWL) during treatment course. Results: The demographic parameters such as sex, age, and stage were evenly distributed in each treatment group. The majority of these patients had Stage IIIA and IIIB disease. Overall median treatment times were 39 days for the CBT group of patients and 62 days for the CTT group. No treatment-related mortality was found. There were 2 patients in the CTT group with acute RTOG Grade 3 lung toxicity, and no Grade 3 lung or esophageal toxicity was observed in CBT group. The response rates, assessed by

  19. Timing of pilocarpine treatment during head and neck radiotherapy: concomitant administration reduces xerostomia better than post-radiation pilocarpine

    International Nuclear Information System (INIS)

    Purpose: To study whether oral pilocarpine administration during and three months after head and neck radiotherapy can prevent or reduce the expected post-radiation xerostomia. This regimen was compared to no treatment and to post-radiotherapy pilocarpine administration, which has previously been shown to reduce symptoms of xerostomia in several randomized trials. Methods: Xerostomia assessments were performed using a visual analog scale xerostomia questionnaire that measures oral dryness, oral comfort, difficulty with sleep, speech and eating. Higher scores indicate less xerostomia. All the patients had all major salivary glands in the initial field treated to ≥ 4,500 cGy. The concomitant pilocarpine group received 5 mg pilocarpine q.i.d. beginning on day one of radiotherapy and continuing for 3 months after completion of radiation. The control group had their baseline xerostomia measured prior to receiving pilocarpine. They subsequently took 5 mg pilocarpine t.i.d. for one month at which time they underwent a second xerostomia assessment. Xerostomia scores for each group were averaged and compared using the Student's t-test. Results: Seventeen patients who received pilocarpine during head and neck irradiation were compared to 12 post-radiotherapy patients who had not yet taken pilocarpine and the same patients after taking pilocarpine for one month. The mean intervals between completion of radiation and evaluation of xerostomia were 16 months for the control group and 17 months for the pilocarpine treated groups. The primary tumor sites treated as well as the total tumor doses were equivalent between the groups. Only one of the pilocarpine treated patients was still taking pilocarpine at the time of evaluation. Results are shown. For each component of xerostomia measured as well as the composite of all components, the group that had received pilocarpine during radiation had significantly less xerostomia than the no pilocarpine group (p<0.01 for each). Post

  20. Concomitant treatment of brain metastasis with Whole Brain Radiotherapy [WBRT] and Temozolomide [TMZ] is active and improves Quality of Life

    International Nuclear Information System (INIS)

    Brain metastases (BM) represent one of the most frequent complications related to cancer, and their treatment continues to evolve. We have evaluated the activity, toxicity and the impact on Quality of Life (QoL) of a concomitant treatment with whole brain radiotherapy (WBRT) and Temozolomide (TMZ) in patients with brain metastases from solid tumors in a prospective Simon two stage study. Fifty-nine patients were enrolled and received 30 Gy WBRT with concomitant TMZ (75 mg/m2/day) for ten days, and subsequently TMZ (150 mg/m2/day) for up to six cycles. The primary end points were clinical symptoms and radiologic response. Five patients had a complete response, 21 patients had a partial response, while 18 patients had stable disease. The overall response rate (45%) exceeded the target activity per study design. The median time to progression was 9 months. Median overall survival was 13 months. The most frequent toxicities included grade 3 neutropenia (15%) and anemia (13%), and only one patient developed a grade 4 thrombocytopenia. Age, Karnofsky performance status, presence of extracranial metastases and the recursive partitioning analysis (RPA) were found to be predictive factors for response in patients. Overall survival (OS) and progression-free survival (PFS) were dependent on age and on the RPA class. We conclude that this treatment is well tolerated, with an encouraging objective response rate, and a significant improvement in quality of life (p < 0.0001) demonstrated by FACT-G analysis. All patients answered the questionnaires and described themselves as 'independent' and able to act on their own initiatives. Our study found a high level of satisfaction for QoL, this provides useful information to share with patients in discussions regarding chemotherapy treatment of these lesions

  1. Reduction of intraocular pressure and improvement of vision after cataract surgeries in angle closure glaucoma with concomitant cataract patients

    OpenAIRE

    Zhang, Zong-Mei; Niu, Qing; Nie, Yan; Zhang, Jin

    2015-01-01

    Objective: This study is to compare the efficacy of three different cataract surgeries in eyes with angle closure glaucoma (ACG) with concomitant cataract. Methods: A retrospective comparative analysis of 106 ACG patients (112 eyes) with concomitant cataract was conducted between February, 2012 and February, 2014. Clinical outcomes of ACG patients with concomitant cataract underwent phacoemulsification and intraocular lens implantation (group A, n = 34, 36 eyes, angle closure < 180°); combine...

  2. Concomitant fibromyalgia in rheumatoid arthritis is associated with the more frequent use of biological therapy

    DEFF Research Database (Denmark)

    Lage-Hansen, P R; Chrysidis, S; Lage-Hansen, M;

    2015-01-01

    OBJECTIVES: To compare the 28-joint Disease Activity Score (DAS28) and its components in patients with rheumatoid arthritis (RA) with and without concomitant fibromyalgia (FM), and to investigate the use of biological treatment in the two groups. METHOD: Questionnaires developed to diagnose FM were...

  3. Concomitant Cryptococcosis and Burkholderia Infection in an Asymptomatic Lung Transplant Patient with Cystic Fibrosis

    OpenAIRE

    2010-01-01

    Concomitant pulmonary infections with Cryptococcus neoformans and Burkholderia cepacia in lung transplant recipients are very rare and create unique diagnostic and therapeutic dilemmas. Herein, we present a double lung transplant patient with cystic fibrosis who was found to have coinfection with these two rare organisms, though he was completely asymptomatic.

  4. Aggressive surgical resection for concomitant liver and lung metastasis in colorectal cancer

    Science.gov (United States)

    Lee, Sung Hwan; Kim, Sung Hyun; Lim, Jin Hong; Kim, Sung Hoon; Lee, Jin Gu; Kim, Dae Joon; Choi, Gi Hong; Choi, Jin Sub

    2016-01-01

    Backgrounds/Aims Aggressive surgical resection for hepatic metastasis is validated, however, concomitant liver and lung metastasis in colorectal cancer patients is equivocal. Methods Clinicopathologic data from January 2008 through December 2012 were retrospectively reviewed in 234 patients with colorectal cancer with concomitant liver and lung metastasis. Clinicopathologic factors and survival data were analyzed. Results Of the 234 patients, 129 (55.1%) had synchronous concomitant liver and lung metastasis from colorectal cancer and 36 (15.4%) had metachronous metastasis. Surgical resection was performed in 33 patients (25.6%) with synchronous and 6 (16.7%) with metachronous metastasis. Surgical resection showed better overall survival in both groups (synchronous, p=0.001; metachronous, p=0.028). In the synchronous metastatic group, complete resection of both liver and lung metastatic lesions had better survival outcomes than incomplete resection of two metastatic lesions (p=0.037). The primary site of colorectal cancer and complete resection were significant prognostic factors (p=0.06 and p=0.003, respectively). Conclusions Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable cases. Colorectal cancer with concomitant liver and lung metastasis is not a poor prognostic factor or a contraindication for surgical treatments, hence, an aggressive surgical approach may be recommended in well-selected resectable cases.

  5. Concomitant parenteral nutrition and systemic cytotoxic therapy in a metastatic colorectal cancer patient

    OpenAIRE

    Popov, A.A.; I. L. Chernikovsky; O. L. Fakhrutdinova; E V Tkachenko

    2012-01-01

    Pathologic nutrients metabolism presents a severe problem in metastatic colorectal cancer patients, especially those with canceromatosis. A hypermetabolism-catabolism syndrome frequently develops in in patients with progressing canceromatosis. This leads to cachexia anorexia syndrome, which significantly impedes available treatment options. Artificial nutrition allows to improve available treatment in such patients. We present a successful case of concomitant parenteral nutrition and systemic...

  6. Concomitant radiotherapy and chemotherapy in head and neck cancer - theoretical rationale and clinical experience

    International Nuclear Information System (INIS)

    Concomitant radiotherapy and chemotherapy in head and neck cancer aims at an interaction between the two modalities which results in improved therapeutic index. Several mechanisms by which this benefit can be achieved are presented. Reviewed are also conclusive randomized trials in which this option has been compared with radiotherapy alone as well as the reasons for difficulties in interpretation of clinical results. (author)

  7. Radiotherapy with concomitant carboplatin (CBDCA) vs cisplatin (CDDP) and superselective arterial infusion of decadose CDDP

    International Nuclear Information System (INIS)

    We compared the effectiveness between carboplatin (CBDCA) and cisplatin (CDDP) as a single-agent chemotherapy and concomitant radiotherapy in operable head and neck cancer by a prospective randomized trial. The CBDCA-treated group (n=60) showed significantly better 5-year local control rate (56.2%) than the CDDP-treated group (n=59, 35.5%, p=0.03). There was no difference in toxicities, which were considered acceptable. We suggest choosing weekly CBDCA rather than daily low-dose CDDP as a chemotherapeutic agent for concomitant chemoradiotherapy in patients with operable cancer, although a dose of CDDP may be too small. Superselective arterial infusion for patients with advanced head and neck cancer has increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Twenty nine patients received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) and conventional concomitant extrabeam radiotherapy. Two year overall survival rate was 42.9%. The primary lesions were well controlled in 21 patients (72.4%). High-frequent acute toxic effects were leukopenia and mucositis. Severe toxic events occurred in three cases, namely, methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, sepsis, and tetraplasia. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol expected the cure of patients with unresectable disease and patients rejecting surgical treatment. (author)

  8. CONCOMITANT INFECTION OF LEPTOSPIROSIS WITH DENGUE AT A TERTIARY CARE HOSPITAL IN CHENNAI

    Directory of Open Access Journals (Sweden)

    Ananthi

    2014-02-01

    Full Text Available BACKGROUND : Concomitant infection of leptospirosis with dengue has been reported in places where these diseases are endemic and leptospirosis may be overlooked in such cases. Recognition of leptospirosis is especially important since antimicrobial agents can reduce its severity a nd duration. Failure to identify leptospirosis in these patients will result in high mortality rate for this infection . Hence this study was conducted to have a detailed knowledge and awareness about the concomitant infection of leptospirosis with dengue. MATERIALS AND METHODS : Patients admitted to the medical ward of Government General Hospital , Chennai with fever of ≥ 5days and of the age group twelve years and above were evaluated for leptospirosis by doing the screening test MSAT (Macroscopic Slide Aggl utination Test. All patients who tested positive for MSAT were further confirmed by MAT (Microscopic Agglutination Test. Those patients who tested positive for leptospirosis were investigated for concomitant infection with dengue utilising IgM ELISA. Pat ients positive for both leptospirosis and dengue were taken up for the study and were evaluated for relevant clinical features and laboratory profile. RESULTS : 143 patients were found to be positive for leptospirosis and among them 4 (2.8% patients were p ositive for the concomitant dengue infection. In the four concomitant infection patients , two were males and two were females , all in the age group of 20 to 30 years. Fever and myalgia were the predominant symptoms in these patients. Thrombocytopenia was s een in 3 (75% patients. With fluid resuscitation , platelet transfusion , appropriate drug and supportive therapy all the four patients recovered. No mortality was observed in this study. CONCLUSION: Increased awareness of concomitant infection and an enhan ced ability to diagnose it early in illness is necessary so that appropriate treatment and supportive measures can be given to reduce the morbidity

  9. A Phase 1/2 and Biomarker Study of Preoperative Short Course Chemoradiation With Proton Beam Therapy and Capecitabine Followed By Early Surgery for Resectable Pancreatic Ductal Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ryan, David P.; Borger, Darrell R.; Blaszkowsky, Lawrence S.; Yeap, Beow Y. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Deshpande, Vikram; Shinagare, Shweta [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wo, Jennifer Y.; Boucher, Yves [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wadlow, Raymond C.; Kwak, Eunice L.; Allen, Jill N.; Clark, Jeffrey W.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Adams, Judith; Winrich, Barbara; Grillo, Tarin [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); and others

    2014-07-15

    Purpose: To evaluate the safety, efficacy and biomarkers of short-course proton beam radiation and capecitabine, followed by pancreaticoduodenectomy in a phase 1/2 study in pancreatic ductal adenocarcinoma (PDAC) patients. Methods and Materials: Patients with radiographically resectable, biopsy-proven PDAC were treated with neoadjuvant short-course (2-week) proton-based radiation with capecitabine, followed by surgery and adjuvant gemcitabine. The primary objective was to demonstrate a rate of toxicity grade ≥3 of <20%. Exploratory biomarker studies were performed using surgical specimen tissues and peripheral blood. Results: The phase 2 dose was established at 5 daily doses of 5 GyE. Fifty patients were enrolled, of whom 35 patients were treated in the phase 2 portion. There were no grade 4 or 5 toxicities, and only 2 of 35 patients (4.1%) experienced a grade 3 toxicity event (chest wall pain grade 1, colitis grade 1). Of 48 patients eligible for analysis, 37 underwent pancreaticoduodenectomy. Thirty of 37 (81%) had positive nodes. Locoregional failure occurred in 6 of 37 resected patients (16.2%), and distant recurrence occurred in 35 of 48 patients (72.9%). With median follow-up of 38 months, the median progression-free survival for the entire group was 10 months, and overall survival was 17 months. Biomarker studies showed significant associations between worse survival outcomes and the KRAS point mutation change from glycine to aspartic acid at position 12, stromal CXCR7 expression, and circulating biomarkers CEA, CA19-9, and HGF (all, P<.05). Conclusions: This study met the primary endpoint by showing a rate of 4.1% grade 3 toxicity for neoadjuvant short-course proton-based chemoradiation. Treatment was associated with favorable local control. In exploratory analyses, KRAS{sup G12D} status and high CXCR7 expression and circulating CEA, CA19-9, and HGF levels were associated with poor survival.

  10. Preoperative Chemoradiation Therapy With Capecitabine/Oxaliplatin and Cetuximab in Rectal Cancer: Long-Term Results of a Prospective Phase 1/2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Fokas, Emmanouil, E-mail: emmanouil.fokas@kgu.de [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Conradi, Lena [Department of General Surgery, University Medical Center of Göttingen (Germany); Weiss, Christian [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Sprenger, Thilo [Department of General Surgery, University Medical Center of Göttingen (Germany); Middel, Peter [Institute for Pathology, University Medical Center, Göttingen (Germany); Rau, Tillman [Institute of Pathology, University Hospital Erlangen, Erlangen (Germany); Dellas, Kathrin [Department of Radiotherapy, Lübeck University (Germany); Kitz, Julia [Institute for Pathology, University Medical Center, Göttingen (Germany); Rödel, Franz [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Sauer, Rolf [Department of Radiation Oncology, University of Erlangen (Germany); Rüschoff, Josef [Targos Molecular Pathology, Kassel (Germany); Beissbarth, Tim [Department of Medical Statistics, University Medical Center of Göttingen (Germany); Arnold, Dirk [Tumor Biology Center Freiburg, University of Freiburg (Germany); Ghadimi, B. Michael [Department of General Surgery, University Medical Center of Göttingen (Germany); Rödel, Claus [Department of Radiation Therapy and Oncology, University of Frankfurt (Germany); Liersch, Torsten [Department of General Surgery, University Medical Center of Göttingen (Germany)

    2013-12-01

    Purpose: We have previously shown that the addition of cetuximab to chemoradiation therapy failed to improve complete response rates (pCR) in rectal cancer. Here we report the long-term results of the cetuximab added to preoperative radiation therapy with capecitabine and oxaliplatin (CET-CAPOX-RT) phase 1/2 study that evaluated preoperative chemoradiation with cetuximab, capecitabine, and oxaliplatin in patients with rectal cancer. Methods and Materials: The median follow-up was 63 months (range, 5-73 months). Sixty patients were enrolled; 3 patients were excluded due to protocol violation, and 4 died before surgery. Total mesorectal excision was performed in 53 patients, in 85% (n=45) with curative intention (M0-status). Secondary end points including overall survival (OS) disease-free survival (DFS) and cancer-specific survival (CSS) were calculated. The prognostic value of KRAS mutation status was also assessed. Results: Histopathological examination confirmed ypUICC stages 0 (n=4; pCR), I (n=17), II (n=10), III (n=14), and IV (n=8). For patients who underwent surgery (n=53), OS at 1, 3, and 5 years was 88.7%, 83%, and 75.5%, respectively, whereas CSS rates were 94.1%, 88.1%, and 78.1%, respectively. In the 45 patients who were treated with curative intent (M0), the OS rates at 1, 3, and 5 years were 91.1%, 88.9%, and 86.7%, respectively; whereas CSS rates were 97.6%, 95.2%, and 90.3%, respectively; and DFS rates were 90.7%, 88.3%, and 88.3%, respectively. We did not find any locoregional failure in patients with M0-status (n=45). Chronic toxicity was rare. KRAS mutations, as detected in 33.3%, showed no correlation with the clinicopathological parameters nor significance for either OS (P=.112), CSS (P=.264), or DFS (P=.565). Conclusions: Taken together, chemoradiation therapy combined with cetuximab is safe, feasible, and offers excellent survival rates. KRAS mutation status was not a predictive factor. Importantly, lack of improvement in pCR rate did not

  11. Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients

    International Nuclear Information System (INIS)

    Purpose: To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency. Methods: During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1–3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12 months. Results: ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis. Conclusion: ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.

  12. Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alparslan, Ahmet; Durmaz, Sedat; Sindel, Timur [Akdeniz University School of Medicine, Department of Radiology (Turkey)

    2012-12-15

    Purpose: To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency. Methods: During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1-3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12 months. Results: ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis. Conclusion: ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.

  13. Comparison of vinorelbine plus cisplatin with vinorelbine plus capecitabine in patients with anthracyclines-and taxanes-refractory advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    Zhendong Zheng; Shuxian Qu; Xiaoxia Chen; Yongye Liu; Ying Piao; Yaling Han; Xiaodong Xie

    2014-01-01

    Objective:The aim of our study was to compare the ef icacy and toxicities of vinorelbine plus cisplatin (NP) regimen with that of vinorelbine plus capecitabine (NX) regimen in the treatment of anthracycline- and taxane-refractory advanced breast cancer. Methods:Forty-six patients with anthracycline-and taxane-refractory advanced breast cancer were equal y randomized into a NP group (n=23) and a NX group (n=23). Response rates and toxicities were evaluated after 2 cycles of chemotherapy. Results:The overal response rate were 48.0%in both groups. There were no significant dif erences in disease control rates (78.0%vs. 83%) or 1-year survival rates (54.6%vs. 55.9%). The main adverse events were bone marrow depression and gastrointestinal reaction, and no significant dif erence was found in toxicities between the groups. Conclusion:For anthracycline-and taxane-refractory advanced breast cancer, NP and NX regimens exerted similar curative ef ects with acceptable toxicity.

  14. EFFECTIVENESS OF I AND II LINE CHEMO-TARGETED THERAPY ACCORDING TO THE SCHEME OXALIPLATIN +CAPECITABINE + BEVACIZUMAB (XELOX+BEV IN PATIENTS WITH METASTATIC COLORECTAL CANCER (MCRC

    Directory of Open Access Journals (Sweden)

    KALDYGUL SMAGULOVA

    2011-08-01

    Full Text Available The research involved 38 mCRC patients, aged 23-73 (medium age -55 years. Patients with mCRC were randomized into two groups. This mode of chemo-targeted therapy was conducted in the first group (20 patents in a second line, since these patients previously were treated by the chemotherapy schemes FOLFIRIor FOLFOX. Patients were treated in the mode: Capecitabine in 2000mg/m2 2 times a day from the 1st to the 14th day, 2-hour infusion of capsular Oxaliplatin 130mg/m2, day 1, Bevacizumab 5mg/kg 1 time per 14 days. The overall objective effect was obtained in 15 patients (39.5±7.9 %: in group 1 - in 7 patients (35.0 + 10.6%, in the 2group - 8 cases (44.4±11.7%, of which complete regression - in 1 (5% and 2 (11.1% cases, respectively. In 30% of cases the partial response and a greater number of stabilization (50% and 44.5% respectively were reported. Progression of the process was observed at 15% in a group 1 and 11.1% of cases in group 2. Terms of remission were group 1 - 8.2 months, group 2 - 12.1 months. Thus, XELOX + BEV shows the sufficient efficacy in patients with mCRC, both in I and II lines of chemotherapy, with an acceptable toxicity profile.

  15. Daily low-dose/continuous capecitabine combined with neo-adjuvant irradiation reduces VEGF and PDGF-BB levels in rectal carcinoma patients

    International Nuclear Information System (INIS)

    Metronomic low-dose chemotherapy regimen was found to have an antiangiogenic effect in tumors. However, its effect on levels of circulating pro-angiogenic and anti-angiogenic factors is not fully explored. Materials and methods. The levels of both VEGF and PDGF-BB were measured in three time points, in the serum of 32 rectal carcinoma patients receiving daily reduced-dose/continuous capecitabine in combination with preoperative pelvic irradiation. Results. We found a significant decrease in VEGF and PDGF-BB serum levels during the combination treatment (p<0.0001), followed by an increase in the successive rest-period (p<0.0001). In addition, substantial changes in platelets counts were observed during treatment in correlation with the changes of VEGF and PDGF-BB serum levels. Discussion. These results suggest that combined chemo-irradiation affect levels of pro-angiogenic factors during treatment, and may reflect an anti-angiogenic window induced during this treatment. The potential implications of this inducible phenomenon, including a possible clinical benefit from the administration of long lasting metronomic chemotherapy immediately following combined chemo-irradiation, would warrant further investigation

  16. Daily low-dose/continuous capecitabine combined with neo-adjuvant irradiation reduces VEGF and PDGF-BB levels in rectal carcinoma patients

    Energy Technology Data Exchange (ETDEWEB)

    Loven, David (Rappaport School of Medicine, The Technion, Haifa (Israel)); Be' Ery, Einat (Sackler Faculty of Medicine, Tel Aviv (Israel)); Yerushalmi, Rinat; Koren, Claude; Sulkes, Aaron; Fenig, Eyal (Rabin Medical Center, Inst. of Oncology, Petach Tikva (Israel)); Lavi, Idit (Dept. of Community Medicine and Epidemiology, Carmel Medical Center, Haifa (Israel)); Shaked, Yuval (Dept. of Molecular and Cellular Biology, Sunnybrook Health Sciences Centre, Toronto (Canada))

    2008-01-15

    Metronomic low-dose chemotherapy regimen was found to have an antiangiogenic effect in tumors. However, its effect on levels of circulating pro-angiogenic and anti-angiogenic factors is not fully explored. Materials and methods. The levels of both VEGF and PDGF-BB were measured in three time points, in the serum of 32 rectal carcinoma patients receiving daily reduced-dose/continuous capecitabine in combination with preoperative pelvic irradiation. Results. We found a significant decrease in VEGF and PDGF-BB serum levels during the combination treatment (p<0.0001), followed by an increase in the successive rest-period (p<0.0001). In addition, substantial changes in platelets counts were observed during treatment in correlation with the changes of VEGF and PDGF-BB serum levels. Discussion. These results suggest that combined chemo-irradiation affect levels of pro-angiogenic factors during treatment, and may reflect an anti-angiogenic window induced during this treatment. The potential implications of this inducible phenomenon, including a possible clinical benefit from the administration of long lasting metronomic chemotherapy immediately following combined chemo-irradiation, would warrant further investigation

  17. A rare case of concomitant hypo-hyperdontia in identical twins

    Directory of Open Access Journals (Sweden)

    Sharma A

    2008-10-01

    Full Text Available Concomitant hypodontia and hyperdontia is a rare condition of unknown etiology. One such case of occurring in identical twins in mixed dentition is presented and discussed. A sibling, especially a twin of an affected patient, should be suspected of having a similar problem, even if he or she is asymptomatic. Genetic factors probably play an important etiological role in the co-occurence of partial anodontia and supernumerary teeth.

  18. Effects of the Kampo Formula Tokishakuyakusan on Headaches and Concomitant Depression in Middle-Aged Women

    OpenAIRE

    Masakazu Terauchi; Shiro Hiramitsu; Mihoko Akiyoshi; Yoko Owa; Kiyoko Kato; Satoshi Obayashi; Eisuke Matsushima; Toshiro Kubota

    2014-01-01

    Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined cross-sectionally the baseline records of 345 women aged 40–59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed t...

  19. Solid pseudopapillary tumor of the pancreas and concomitant urogenital malformations in a young woman

    OpenAIRE

    Guan, Zhi-Wei; Lu SUN; Wang, Yan-Qiu; Xu, Bai-Xuan

    2013-01-01

    Abstract Solid pseudopapillary tumor (SPT) of the pancreas is a rare pancreatic tumor with low malignant potential. It occurs characteristically more often in young women. SPT associated with extra- and pancreatic anomalies are occasionally reported. Here we report a case of pancreatic SPT with concomitant urogenital malformations including solitary kidney and uterus didelphys in a 25-year-old woman. The patient underwent central pancreatectomy, and SPT was confirmed with pathological results...

  20. Radiochemoimmunotherapy with intensity-modulated concomitant boost: interim analysis of the REACH trial

    OpenAIRE

    Jensen Alexandra D; Krauss Jürgen; Potthoff Karin; Simon Christian; Nikoghosyan Anna V; Lossner Karen; Debus Jürgen; Münter Marc W

    2012-01-01

    Abstract Purpose To evaluate efficacy and toxicity clinical in the intensified treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) with the combination of chemotherapy, the EGFR antibody cetuximab, and intensity-modulated radiation therapy (IMRT) in a concomitant boost concept. Methods REACH is a prospective, bi-centric phase II trial of carboplatin/5-FU and cetuximab weekly combined with IMRT. Primary endpoint is locoregional control, secondary endpoints includ...

  1. Paclitaxel and concomitant radiotherapy in high-risk endometrial cancer patients: preliminary findings

    OpenAIRE

    Frigerio Luigi; Viganò Riccardo; Rabaiotti Emanuela; Beatrice Saverio; De Marzi Patrizia; Mangili Giorgia; Gentile Cinzia; Fazio Ferruccio

    2006-01-01

    Abstract Background There is still much debate about the best adjuvant therapy after surgery for endometrial cancer (EC) and there are no current guidelines. Radiotherapy (RT) alone does not seem to improve overall survival. We investigated whether concomitant Paclitaxel (P) and RT gave better clinical results. Methods Twenty-three patients with high-risk EC (stage IIB, IIIA, IIIC or IC G3 without lymphadenectomy or with aneuploid tumor) underwent primary surgery and were then referred for ad...

  2. Solid Pseudopapillary Tumor of the Pancreas with Concomitant Pancreas Divisum. A Case Report

    OpenAIRE

    Daisuke Watanabe; Kouichi Miura; Takashi Goto; Hirohide Ohnishi; Hiroshi Nanjo; Yuzo Yamamoto

    2010-01-01

    Context Solid pseudopapillary tumor of the pancreas is a rare neoplasm which affects young women. On the other hand, pancreas divisum is an anomaly which develops at 7 weeks of gestation. Here, we report a case of a solid pseudopapillary tumor of the pancreas with concomitant pancreas divisum. Case report A 26-year-old woman was diagnosed as having a pancreatic tumor with solid and cystic components in the pancreatic head. Pancreatograms obtained by ERCP and MRCP showed no communication betwe...

  3. The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT

    International Nuclear Information System (INIS)

    Purpose: To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer. Materials and methods: The incidence of high grade (⩾G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D50) were reported using non-linear logistic regression analysis. Results: Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65 Gy in 30 daily fractions to the primary site and involved nodal groups and 54 Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were comparable. Concomitant cisplatin 100 mg/m2 was administered on days 1 and 29 of IMRT. The incidence of ⩾G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p = 0.83; late-43% (IMRT) versus 34% (c-IMRT), p = 0.51. Recovery of parotid salivary flow at 1 year was higher with IMRT (64% vs 50%), but not statistically significant (p = 0.15). D50 for absence of parotid saliva flow at 1 year was 23.2 Gy (95% CI: 17.7–28.7) for IMRT and 21.1 Gy (11.8–30.3) for c-IMRT. Conclusion: Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone

  4. Risk factors for intestinal metaplasia in concomitant gastric and duodenal ulcer disease

    OpenAIRE

    Hong, Jun-Bo; Xia, Liang; Zuo, Wei; Wang, An-Jiang; Xu, Shan; Xiong, Hui-Fang; Chen, You-Xiang; ZHU, XUAN; LU, NONG-HUA

    2014-01-01

    The aim of this study was to estimate the prevalence and risk factors of intestinal metaplasia (IM) in concomitant gastric and duodenal ulcer (CGDU) disease by retrospectively reviewing consecutive patients who had undergone esophagogastroduodenal endoscopy. Patients who received the endoscopic diagnosis of CGDU disease were selected for analysis and the recorded demographic, endoscopic, clinical and outcome data, including data on the development of IM, were extracted. Associations of the va...

  5. Tinea Corporis and Concomitance of Rosacea Triggered By Systemic Steroid Treatment

    Directory of Open Access Journals (Sweden)

    Erdem H et al.

    2011-10-01

    Full Text Available Tinea corporis is a superficial dermatophyte infection characterized by either inflammatory or noninflammatory lesions on the glabrous skin (ie, skin regions except the scalp, groin, palms, and soles. Rosacea is a common inflammatory disease in which numerous etiologic and triggering factors play a role, and characterized with flushing episodes, telangiectasias, and recurrent inflammatory papules and pustules. Herein, we report a case of concomitance of rosacea triggered by systemic steroid treatment and tinea corporis with atypical clinic presentation.

  6. Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

    OpenAIRE

    Castleberry, A W; Martin, J. T.; Osho, A. A.; Hartwig, M. G.; Hashmi, Z. A.; Zanotti, G.; Shaw, L. K.; J. B. Williams; Lin, S. S; Davis, R. D.

    2013-01-01

    Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipien...

  7. Biepicondylar fracture dislocation of the elbow joint concomitant with ulnar nerve injury

    OpenAIRE

    Konya, M Nuri; Aslan, Ahmet; Sofu, Hakan; Yıldırım, Timur

    2013-01-01

    In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open redu...

  8. Concomitant Antibiotic and Mercury Resistance Among Gastrointestinal Microflora of Feral Brook Trout, Salvelinus fontinalis

    OpenAIRE

    Meredith, Matthew M.; Parry, Erin M.; Guay, Justin A.; Markham, Nicholas O.; Danner, G. Russell; Johnson, Keith A.; Barkay, Tamar; Fekete, Frank A.

    2012-01-01

    Twenty-nine bacterial isolates representing eight genera from the gastrointestinal tracts of feral brook trout Salvelinus fontinalis (Mitchell) demonstrated multiple maximal antibiotic resistances and concomitant broad-spectrum mercury (Hg) resistance. Equivalent viable plate counts on tryptic soy agar supplemented with either 0 or 25 μM HgCl2 verified the ubiquity of mercury resistance in this microbial environment. Mercury levels in lake water samples measured 1.5 ng L−1; mercury concentrat...

  9. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    OpenAIRE

    Nasser Janmohammadi

    2014-01-01

    Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trime...

  10. Concomitant Laparoendoscopic Single-Site Surgery for Ureterolithotomy and Contralateral Renal Cyst Marsupialization

    OpenAIRE

    Lee, Joo Yong; Lee, Seung Wook

    2011-01-01

    A 63-year-old woman presented with acute right-flank pain and left-flank pain. Computed tomography identified a right ureter stone and a left renal cyst. The patient underwent concomitant laparoendoscopic single-site surgery (LESS) for ureterolithotomy and renal cyst marsupialization with the use of an Alexis® wound retractor, which was inserted through the umbilical incision. Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure simi...

  11. A Case of Nongerminomatous Germ Cell Tumor with Fulminant Course Concomitant Leptomeningeal Metastasis.

    Science.gov (United States)

    Jeong, Youn-Beom; Wang, Kyu-Chang; Phi, Ji Hoon; Lee, Ji Yeoun; Cheon, Jung-Eun; Kang, Hyoung Jin; Kim, Il Han; Kim, Seung-Ki

    2016-04-01

    We present the case of a 9-year-old boy with a non-germinomatous germ cell tumor (NGGCT) in the pineal gland that exhibited a fulminant course following chemo- and radiotherapy. After the detection of the tiny cerebellar enhancing nodule at the end of chemo- and radiotherapy, tumor seeding progressed rapidly into the entire cisternal space. We herein report a rare case of NGGCT with fulminant clinical course of concomitant cerebellar seeding, with review of literature. PMID:27195258

  12. Increase of malaria attacks among children presenting concomitant infection by Schistosoma mansoni in Senegal

    OpenAIRE

    Diop Mamadou; Camara Pape; Akiana Jean; Mbaye Pape A; Le Hesran Jean-Yves; Sokhna Cheikh; Ly Abdoulaye; Druilhe Pierre

    2004-01-01

    Abstract Helminthic infections concomitant with malaria are common in inter-tropical areas. A recent study showed that mice co-infected with Schistosoma mansoni and Plasmodium chabaudi develop higher P. chabaudi parasitaemia and had a higher mortality rate. This important observation deserved to be further investigated among human populations. Malaria attacks were recorded in 512 children aged 6–15 years living in Richard Toll (Northern Senegal) among whom 336 were infected by S. mansoni, and...

  13. Concomitant chemotherapy and radiotherapy in the adjuvant treatment of breast cancer

    International Nuclear Information System (INIS)

    The conventional treatment of localized breast cancer involves the use of both systemic therapy and loco-regional radiation after surgery. The ideal sequence of these two treatments is still undefined. This paper focus on our experience of concomitant chemotherapy (CT) and radiotherapy (RT), and discusses information from the literature about this issue. Between Jan,1989 and Jan, 1999 a retrospective analysis of 103 patients with ductal carcinoma of the breast who received concomitant CT with cyclophosphamide, methotrexate and 5 flurouracil (CMF) and RT was made. Radiation did not included mammary chain or axilla and total dose was of 50 Gy. End points were tolerance and oxicity leading changes to doses. Mean age was 44y; median follow up time of 33 mo; 62 patients had breast conserving surgery and 41 had mastectomy. All patients received both treatments without a break or dose modification. There was no change or interruption of RT. Ten out of 103 patients had the prescribed dose of CT decreased of 10%-20%. There was no evident changes in cosmetic results. Most of the knowledge regarding the delay of CT or RT comes from retrospective studies, and results are conflicting. It is well accepted that high risk patients need both CT and RT. However, there are data suggesting that giving RT first and CT after may increase the rate of distant metastases. There are also studies showing worse impact in the local control with the delay of radiotherapy. The use of concomitant chemotherapy and radiotherapy has apparent advantages, but no randomized trial has addressed this issue yet. Our experience has shown that is possible to give concomitant CT with CMF and RT without irradiation of IMC and axilla without major changes in scheduling or dose of both therapies. (author)

  14. The results of accelerated radiotherapy and concomitant cisplatin administration in advanced oropharyngeal cancer

    International Nuclear Information System (INIS)

    The accelerated radiotherapy and concomitant infusion of cisplatin in low doses was evaluated in 15 patients with advanced squamous cell carcinoma of the oral cavity and oral part of pharynx. Clinical complete response was seen in 6 of 15 patients (40%) and 4 patients (26.6%) were alive 12 months with no evidence of disease, of all group of 15 patients 9 (60%) were alive 12 months after treatment. (author)

  15. Concomitant parenteral nutrition and systemic cytotoxic therapy in a metastatic colorectal cancer patient

    Directory of Open Access Journals (Sweden)

    A. A. Popov

    2015-02-01

    Full Text Available Pathologic nutrients metabolism presents a severe problem in metastatic colorectal cancer patients, especially those with canceromatosis. A hypermetabolism-catabolism syndrome frequently develops in in patients with progressing canceromatosis. This leads to cachexia anorexia syndrome, which significantly impedes available treatment options. Artificial nutrition allows to improve available treatment in such patients. We present a successful case of concomitant parenteral nutrition and systemic cytotoxic therapy in metastatic colorectal cancer patient with peritoneal canceromatosis.

  16. Successful Hematopoietic Stem Cell Transplantation Following a Cyclophosphamide-Containing Preparative Regimen with Concomitant Phenobarbital Administration

    OpenAIRE

    Catherine Weber; Heather Kasberg; Edward Copelan

    2012-01-01

    Cyclophosphamide is an immunosuppressive agent and an anticancer prodrug which requires bioactivation catalyzed primarily by cytochrome P450 enzymes in order to be transformed into its active alkylating compounds. Concomitant administration of drugs known to inhibit or induce this enzyme system is a clinical concern. Herein, we present the case of a chronically ill 21-year-old patient who received high-dose cyclophosphamide, equine antithymocyte globulin (eATG), and total body irradiation (TB...

  17. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes to...

  18. Clinical results of a concomitant boost radiotherapy technique for muscle-invasive bladder cancer

    International Nuclear Information System (INIS)

    Purpose: to update the results of external radiotherapy with a focal concomitant boost technique on local control and bladder function in patients with muscle-invasive bladder cancer. Patients and methods: the authors retrospectively evaluated 92 elderly or disabled patients with localized T2-4 N0-1 M0 transitional cell carcinoma of the bladder and a median age of 79 years, not suitable for radical surgery and treated between 1994 and 2005. Treatment consisted of a dose of 40 Gy/2 Gy to the small pelvis with a daily concomitant boost of 0.75 Gy to the tumor. Total dose was 55 Gy in 4 weeks. Results: complete remission rate after evaluation by means of cystoscopy at 3 months was 78%. 3-year local control rate amounted to 56%, and 3-year overall survival to 36%. The posttreatment bladder capacity was comparable with the pretreatment capacity and was ≥ 200 ml in 81% of the cases. Mean bladder capacity did not deteriorate at longer follow-up. Conclusion: the local control rate after external beam radiotherapy in elderly patients with a focal concomitant boost for localized muscle-invasive bladder cancer was 56% at 3 years. Functional bladder outcome was good. (orig.)

  19. Clinical results of a concomitant boost radiotherapy technique for muscle-invasive bladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Piet, A.H.M.; Hulshof, M.C.C.M.; Pieters, B.R.; Koning, C.C.E. [Dept. of Radiation Oncology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Pos, F.J. [Dept. of Radiation Oncology, The Netherlands Cancer Inst., Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Reijke, T.M. de [Dept. of Urology, Academic Medical Center, Univ. of Amsterdam (Netherlands)

    2008-06-15

    Purpose: to update the results of external radiotherapy with a focal concomitant boost technique on local control and bladder function in patients with muscle-invasive bladder cancer. Patients and methods: the authors retrospectively evaluated 92 elderly or disabled patients with localized T2-4 N0-1 M0 transitional cell carcinoma of the bladder and a median age of 79 years, not suitable for radical surgery and treated between 1994 and 2005. Treatment consisted of a dose of 40 Gy/2 Gy to the small pelvis with a daily concomitant boost of 0.75 Gy to the tumor. Total dose was 55 Gy in 4 weeks. Results: complete remission rate after evaluation by means of cystoscopy at 3 months was 78%. 3-year local control rate amounted to 56%, and 3-year overall survival to 36%. The posttreatment bladder capacity was comparable with the pretreatment capacity and was {>=} 200 ml in 81% of the cases. Mean bladder capacity did not deteriorate at longer follow-up. Conclusion: the local control rate after external beam radiotherapy in elderly patients with a focal concomitant boost for localized muscle-invasive bladder cancer was 56% at 3 years. Functional bladder outcome was good. (orig.)

  20. Incidence Rate of Concomitant Systemic Diseases in the Aging Population with Postmenopausal Osteoporosis

    Directory of Open Access Journals (Sweden)

    Selçuk Sayılır

    2016-08-01

    Full Text Available Objective: To evaluate the concomitant systemic diseases with postmenopausal osteoporosis and to investigate the points to be considered in treatment approach of patients with osteoporosis. Materials and Methods: The study included 110 female patients admitted to our clinic and followed up after postmenopausal osteoporosis diagnosis. Besides the demographic data; the concomitant diseases of the patients such as hypertension, hypo-hyperthyroidism, diabetes mellitus, Alzheimer’s disease, malignancy, osteoarthritis, gastrointestinal system diseases, chronic obstructive pulmonary disease (COPD- asthma and depression were also recorded. Results: The mean age of the patients included in our study was 65.9±9.8 years. When the concomitant systemic diseases were examined; 40 patients had hypertension, 32 patients had osteoarthritis, 24 patients had gastrointestinal tract problems, 22 patients had thyroid disease, 21 patients had depression, 15 patients had hyperlipidemia, 12 patients had diabetes mellitus, 10 patients had COPD - asthma, 7 patients had cardiac diseases, 5 patients had malignancy and 2 patients had Alzheimer disease. Conclusion: Osteoporosis is a common disease in the geriatric population. As a chronic disease with an increasing incidence with aging; it can cause many health problems, prevalently pathological bone fractures, in our country and all over the world. Constitutively, prophylaxis of osteoporosis should be the first step. Because systemic diseases with increasing incidence with aging may affect the severity of osteoporosis and impair the treatment; it is important for both clinicians and the society to have sufficient information about osteoporosis.

  1. The concomitant use of indigenous soil bacteria and fungi to enhance the bioremediation of refinery waste

    Energy Technology Data Exchange (ETDEWEB)

    Campos Carvalho, F.J.P. de [Universidade Federal do Parana, Curitiba (Brazil)

    2001-07-01

    Usually, the use of indigenous soil bacteria for the remediation of petroleum-contaminated soils was restricted to the biodegradation of low-molecular weight petroleum hydrocarbons such as gasoline, diesel, fuel oil and jet fuel. The advantage of using indigenous microorganisms is the minimization of the impact of the treatment on the microbial diversity. As a rule,these techniques are also well accepted by the public. Other studies have shown that fungi is successful for the bioremediation of heavier-weight contaminants. The concomitant transformation of low-molecular weight and heavier recalcitrant oil fractions to inorganic and humic form can be accomplished with the concomitant action of bacteria and fungi. The development of a soil biotreatment program using this concomitant technique was performed by PETROBRAS Petroleo Brasileiro S.A. - Refinaria Presidente Getulio Vargas in conjunction with the Universidade Federal do Parana. It resulted in a full-scale technology that allows the degradation of oil waste. Approximately two years of treatment are required to achieve the desired results. The use of standard analytical methods and bioindicators used on the treated soil indicated that the treated soil met the standards for agricultural soil quality. A recent oil spill occurred in Araucaria, Brazil and a bioremediation area was inoculated, and to date the results prove the beneficial effects to be derived from the use of inoculation. Some results were presented in table format. 3 tabs.

  2. Toxic epidermal necrolysis due to concomitant use of valproic asid and lamotrigine

    Directory of Open Access Journals (Sweden)

    Hamdi Özcan

    2015-06-01

    Full Text Available Toxic epidermal necrolysis (TEN is a rare but life-threatening acute mucacutaneous hypersensitivity reaction, usually related to medications. Concomitant use of lamotrigine and valproic asid can cause this serious reaction. A 36 year-old-man admitted to emergency department with high fever, burning sensation at eyes, oral and genital mucous erosions, generalized rush and weakness. He had been taking valproic asid, olanzapine, and sertraline for bipolar affective disorder. Lamotrigine 25 mg/day treatment was added his treatment protocol 15 days ago before the rush and lamotgine dose was increased 50 mg/day 10 days later. The patient was diagnosed as TEN caused by concomitant use of valproic asid and lamotrigine. The patient followed up and treated at burn unit with intravenous immunoglobulin, corticosteroid and antibiotics. Concomitant use of valproic asid and lamotrigine increases the frequency of adverse reaction. TEN may cause serious complications and mortality. The patients with TEN should be followed by a multi-disciplinary team. Early determination of complications and suitable management can increase survival.

  3. Non-Dimensional Formulation of Ventricular Work-Load Severity Under Concomitant Heart Valve Disease

    Science.gov (United States)

    Dong, Melody; Simon-Walker, Rachael; Dasi, Lakshmi

    2012-11-01

    Current guidelines on assessing the severity of heart valve disease rely on dimensional disease specific measures and are thus unable to capture severity under a concomitant heart valve disease scenario. Experiments were conducted to measure ventricular work-load in an in-house in-vitro left heart simulator. In-house tri-leaflet heart valves were built and parameterized to model concomitant heart valve disease. Measured ventricular power varied non-linearly with cardiac output and mean aortic pressure. Significant data collapse could be achieved by the non-dimensionalization of ventricular power with cardiac output, fluid density, and a length scale. The dimensionless power, Circulation Energy Dissipation Index (CEDI), indicates that concomitant conditions require a significant increase in the amount of work needed to sustain cardiac function. It predicts severity without the need to quantify individual disease severities. This indicates the need for new fluid-dynamics similitude based clinical guidelines to assist patients with multiple heart valve diseases. Funded by the American Heart Association.

  4. Presumed Isotretinoin-Induced, Concomitant Autoimmune Thyroid Disease and Ocular Myasthenia Gravis: A Case Report

    Directory of Open Access Journals (Sweden)

    Huseyin Gursoy

    2012-11-01

    Full Text Available Introduction: There are many adverse effects that have been described for isotretinoin. To the best of our knowledge, this is the first report of a possible association of oral isotretinoin intake with autoimmune thyroiditis and ocular myasthenia gravis (OMG. Case Presentation: A 19-year-old Caucasian male, who had used oral isotretinoin for severe acne disease for the previous six months, was referred to our clinic. He had a three-week history of diplopia and variable bilateral ptosis. Physical examination showed moderate periorbital edema and limitations of up- and down-gaze in the left eye. Laboratory findings and thyroid ultrasound were consistent with autoimmune thyroiditis. Antithyroid therapy did not relieve the clinical symptoms. Concomitant OMG was suspected. Variable ptosis and a positive response to oral prednisolone of 40 mg/day and pyridostigmine of 360 mg/day supported the diagnosis of concomitant autoimmune thyroiditis and OMG. Conclusion: Autoimmune disorders may be triggered by oral isotretinoin treatment. Clinicians prescribing isotretinoin should be aware of the possible association between isotretinoin intake and concomitant autoimmune thyroiditis and OMG.

  5. Curative effect observation of capecitabine in maintenance treatment of metastatic breast cancer after chemotherapy%转移性乳腺癌化疗后卡培他滨维持治疗疗效观察

    Institute of Scientific and Technical Information of China (English)

    龚子永; 杨成轩

    2015-01-01

    Objective To observe the curative effect of capecitabine in maintenance treatment of metastatic breast cancer after chemotherapy. Methods A total of 34 patients with metastatic breast cancer after chemotherapy were divided into treatment group and non-treatment group with 17 cases in each group. The treatment group received oral administration of 2500 mg/m2 of capecitabine for 14 d. Every 21 days were taken as 1 treatment course. Curative effect was evaluated after 2 treatment courses. Results The median progression time of the treatment group (11 months) was longer than the non-treatment group (8 months), and the difference had statistical significance (P<0.05). Conclusion Capecitabine can suspend progression time in maintenance treatment of metastatic breast cancer after chemotherapy.%目的:观察转移性乳腺癌经过化疗后应用卡培他滨维持治疗的效果。方法34例转移性乳腺癌患者应用常规化疗后分为治疗组和未治疗组,各17例。治疗组口服卡培他滨2500 mg/m2,14 d,每21天1个周期。治疗2个周期后开始评价疗效。结果随访治疗组的中位疾病进展时间(11个月)长于未治疗组(8个月),两组差异有统计学意义(P<0.05)。结论卡培他滨用于转移性乳腺癌化疗后维持治疗能延缓疾病进展时间。

  6. Clinical observation of Maintenance Treatment of Capecitabine for Metastatic Breast Cancer%卡培他滨维持治疗转移性乳腺癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    彭小波; 王梅; 王薇; 吴梅红; 王雅杰

    2014-01-01

    Objective To observe the efficacy and toxicities of maintenance chemotherapy with capecitabine for meta -static breast cancer ( MBC) .Methods Advanced metastatic breast cancer patients who achieved disease control with first -line treatment received capecitabine as maintenance chemotherapy until disease progression .Capecitabine was administered at a dose of 1 000 mg/m2 ,twice daily,for 14 days,followed by a 7-day rest period,every 3 weeks.Results 30 patients finished 124 cycles of maintenance chemotherapy .Median progression free survival time was 6.8 months (2.9~19.0 months).The main side effects were hand-foot syndrome and leucopenia which were tolerable .Conclusion Maintenance chemotherapy with capecitabine for metastatic breast cancer can extend progression free survival time with tolerable side effects .%目的:观察应用卡培他滨维持治疗转移性乳腺癌患者的疗效及不良反应。方法对一线化疗疾病获得控制的晚期转移性乳腺癌患者,给予卡培他滨单药维持化疗直至疾病进展,具体给药方案:1000 mg/m2口服,每天2次,第1~14天持续给药,每3周重复。结果30例转移性乳腺癌患者共完成维持化疗124个周期,中位无进展生存时间(MPFS)为6.8个月(2.9~19.0个月)。主要不良反应为手足综合征和白细胞减少,但均可耐受。结论转移性乳腺癌患者给予卡培他滨维持治疗,可明显延长患者的无进展生存期,同时不良反应均可耐受。

  7. Expressions of Thymidylate Synthase, Thymidine Phosphorylase, Class Ⅲ β-tubulin, and Excision Repair Cross-complementing Group 1 Predict Response in Advanced Gastric Cancer Patients Receiving Capecitabine Plus Paclitaxel or Cisplatin

    Institute of Scientific and Technical Information of China (English)

    Ming Lu; Jing Gao; Xi-cheng Wang; Lin Shen

    2011-01-01

    Objective:To evaluate the role of class Ⅲ β-tubulin (TUBB3),thymidylate synthase (TS),thymidine phosphorylase (TP),and excision repair cross-complementing group 1 (ERCC1) in clinical outcome of advanced gastric cancer patients receiving capecitabine plus paclitaxel or cisplatin.Methods:The clinical data and tumor specimens from 57 advanced gastric cancer patients receiving first-line capecitabine plus paclitaxel (cohort 1,n=36) and capecitabine plus cisplatin (cohort 2,n=21) were retrospectively collected,and TUBB3,TS,TP,and ERCC1 expressions were detected by real-time quantitative PCR.The associations between expressions of biomarkers and response or survival were analyzed statistically.Results:The median age of 57 patients was 57 years (range:27-75 years) with 38 males and 19 females.Of all patients,the response rates of patients with high TP,low TP and high TS,low TS expressions were 57.1%,27.6% (P=0.024),and 55.2%,28.6% (P=0.042),respectively.Among cohort 1,the response rates and median overall survivals of patients with low and high TUBB3 expressions were 61.1% vs.33.3% (P=0.095) and 13.8 months vs.6.6 months (P=0.019),respectively; the response rate (87.5%) of patients with low TUBB3 and high TP expressions was higher than that (14.3%) of patients with high TUBB3 and low TP expressions (P=0.01).Among cohort 2,the response rates of patients with low ERCC1 and high ERCC1 expressions were 45.5% and 20.0% respectively (P=0.361).Conclusion:TUBB3,TS and TP expressions could predict the response of advanced gastric cancer patients receiving capecitabine-based and paclitaxel-based chemotherapy.These results will be further confirmed in future large samples.

  8. A phase I/II study of biweekly capecitabine and irinotecan plus bevacizumab as second-line chemotherapy in patients with metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Suenaga M

    2015-03-01

    Full Text Available Mitsukuni Suenaga,1 Nobuyuki Mizunuma,1 Satoshi Matsusaka,1 Eiji Shinozaki,1 Masato Ozaka,1 Mariko Ogura,1 Keisho Chin,1 Toshiharu Yamaguchi2 1Department of Gastroenterology, 2Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake, Koto-ku, Tokyo, Japan Background: Triweekly capecitabine plus irinotecan (XELIRI is not completely regarded as a valid substitute for fluorouracil, leucovorin, and irinotecan (FOLFIRI in metastatic colorectal cancer (mCRC because of the potential for greater toxicity. We conducted a phase I/II study to assess the efficacy and safety of biweekly XELIRI plus bevacizumab (BV as second-line chemotherapy for mCRC.Methods: Patients with mCRC who had received prior chemotherapy including oxaliplatin and BV and had a UGT1A1 genotype of wild-type or heterozygous for UGT1A1*6 or *28 were eligible for this study. Treatment comprised capecitabine 1,000 mg/m2 twice daily from the evening of day 1 to the morning of day 8, intravenous irinotecan on day 1, and BV 5 mg/kg on day 1 every 2 weeks. The phase I study consisted of two steps (irinotecan 150 and 180 mg/m2, and dose-limiting toxicity was assessed during the first treatment cycle. The primary endpoint of the phase II study was progression-free survival (PFS.  Results: The recommended dose of irinotecan was determined to be 180 mg/m2 in the phase I study. Between November 2010 and August 2013, 44 patients were enrolled in phase II. The patients’ characteristics were as follows (N=44: median age, 60 years (range 32–80; male/female, 21/23; and UGT1A1 wild-type/heterozygous, 29/15. The median PFS was 6.8 months (95% confidence interval, 5.3–8.2 months, and the primary endpoint was met. Median overall survival was 18.3 months. The response rate was 22.7%. There was no significant difference in PFS or overall survival according to UGT1A1 status. Grade 3 or higher adverse events were mainly neutropenia in six

  9. First Case of Complete Bladder Duplication in the Coronal Plane with Concomitant Duplication of the Urethra in an Adult Male

    Directory of Open Access Journals (Sweden)

    Nikolaos Karpathakis

    2013-01-01

    Full Text Available Duplication of the lower urinary tract is a very rare congenital anomaly which is diagnosed either at birth or during early childhood. These rare malformations are most of the times accompanied by other concomitant anomalies and are therefore diagnosed immediately after birth. In some even rarer cases there are no concomitant anomalies and symptoms thus leading to a diagnosis later in childhood. This is the first case in the literature of complete bladder duplication in the coronal plane with concomitant duplication of the urethra and no other associated anomalies in a 52-year-old male who remained asymptomatic and therefore undiagnosed for more than 5 decades.

  10. Rill Initiation

    OpenAIRE

    Ottosen, Thor-Bjørn

    2008-01-01

    This project is about rill erosion. The aim is to test whether rill initiation can be predicted from the shear strength of the soil as measured with a torvane on saturated soil. This approach was set forward by Rauws and Govers 1988. Rainfall simulation experiments are conducted at a plot size 2x1m, performed in May on the Marbjerg experimental field. The results are evaluated using a chain set to measure alterations of the surface roughness as a result of the erosion, visual evaluation of ph...

  11. 抗癌药卡培他滨对四膜虫的生态毒性研究%Toxicity of Capecitabine to Protozoa TetrahymenaThermophila

    Institute of Scientific and Technical Information of China (English)

    何忠; 高礼; 白琦锋; 袁涛

    2012-01-01

    水环境抗癌药残留的生态毒性效应是当前环境领域研究热点。本文以四膜虫为模式生物,研究了抗癌药卡培他滨(CAP)对四膜虫的毒性作用。结果表明,0.25-16μMCAP对四膜虫的生长抑制无显著影响。CAP对罗丹明B在四膜虫体内积累的试验结果显示CAP对四膜虫的多药耐药性(MDR)的影响亦不显著。研究结果提示,要进一步探索敏感物种和敏感分子指标,同时考虑CAP代谢产物的生态毒性,为科学认识和评价抗癌药生态风险积累基础数据。%The toxic effects of capecitabine to model organism protozoa Tetrahymenathermophila were evaluated.The results showed that 0.25-16 μM CAP had no significant effect on the growth of Tetrahymena thermophile.The accumulation test of Rhodamine B in Tetrahymena thermophile showed that CAP has little influence on its multidrug resistance.It was suggested that more attention should be paid to explore sensitive species and sensitive molecular indicator and consider ecotoxicity of the metabolite of CAP.This study accumulates datafor the ecological risk assessments and scientific understandings of the pollutant.

  12. The predictive value of microRNA-126 in relation to first line treatment with capecitabine and oxaliplatin in patients with metastatic colorectal cancer

    International Nuclear Information System (INIS)

    MicroRNA-126 is the only microRNA (miRNA) known to be endothelial cell-specific influencing angiogenesis in several ways. The aim of the present study was to analyse the possible predictive value of miRNA-126 in relation to first line capecitabine and oxaliplatin (XELOX) in patients with metastatic colorectal cancer (mCRC). The study included 89 patients with mCRC. In situ hybridization (ISH) was performed to detect miRNA-126 in formalin-fixed paraffin embedded tissue from primary tumours. The expression of miRNA-126, area per image (μm2), was measured using image analysis. Clinical response was evaluated according to RECIST. Progression free survival (PFS) was compared using the Kaplan-Meier method and the log rank test. Tumours were classified as low or high miRNA-126 expressing tumours using the median value from the patients with response as cut-off. The median miRNA-126 expression level was significantly higher in patients responding to XELOX, 3629 μm2 (95% CI, 2566-4846), compared to the patients not responding, 1670 μm2 (95% CI, 1436-2041), p < 0.0001. The positive predictive value was 90%, and the negative predictive value was 71%. The median PFS of patients with high expressing tumours was 11.5 months (95% CI, 9.0-12.7 months) compared to 6.0 months (95% CI, 4.8-6.9 months) for patients with low expressing tumours, p < 0.0001. Angiogenesis quantified by ISH of miRNA-126 was related to response to first line XELOX in patients with mCRC, translating to a significant difference in PFS. The predictive value of miRNA-126 remains to be further elucidated in prospective studies

  13. (19)F MRSI of capecitabine in the liver at 7 T using broadband transmit-receive antennas and dual-band RF pulses.

    Science.gov (United States)

    van Gorp, Jetse S; Seevinck, Peter R; Andreychenko, Anna; Raaijmakers, Alexander J E; Luijten, Peter R; Viergever, Max A; Koopman, Miriam; Boer, Vincent O; Klomp, Dennis W J

    2015-11-01

    Capecitabine (Cap) is an often prescribed chemotherapeutic agent, successfully used to cure some patients from cancer or reduce tumor burden for palliative care. However, the efficacy of the drug is limited, it is not known in advance who will respond to the drug and it can come with severe toxicity. (19)F Magnetic Resonance Spectroscopy (MRS) and Magnetic Resonance Spectroscopic Imaging (MRSI) have been used to non-invasively study Cap metabolism in vivo to find a marker for personalized treatment. In vivo detection, however, is hampered by low concentrations and the use of radiofrequency (RF) surface coils limiting spatial coverage. In this work, the use of a 7T MR system with radiative multi-channel transmit-receive antennas was investigated with the aim of maximizing the sensitivity and spatial coverage of (19)F detection protocols. The antennas were broadband optimized to facilitate both the (1)H (298 MHz) and (19)F (280 MHz) frequencies for accurate shimming, imaging and signal combination. B1(+) simulations, phantom and noise measurements showed that more than 90% of the theoretical maximum sensitivity could be obtained when using B1(+) and B1(-) information provided at the (1)H frequency for the optimization of B1(+) and B1(-) at the (19)F frequency. Furthermore, to overcome the limits in maximum available RF power, whilst ensuring simultaneous excitation of all detectable conversion products of Cap, a dual-band RF pulse was designed and evaluated. Finally, (19)F MRS(I) measurements were performed to detect (19)F metabolites in vitro and in vivo. In two patients, at 10 h (patient 1) and 1 h (patient 2) after Cap intake, (19)F metabolites were detected in the liver and the surrounding organs, illustrating the potential of the set-up for in vivo detection of metabolic rates and drug distribution in the body. PMID:26373355

  14. Concomitant bidirectional transport during peritoneal dialysis can be explained by a structured interstitium.

    Science.gov (United States)

    Stachowska-Pietka, Joanna; Waniewski, Jacek; Flessner, Michael F; Lindholm, Bengt

    2016-06-01

    Clinical and animal studies suggest that peritoneal absorption of fluid and protein from dialysate to peritoneal tissue, and to blood and lymph circulation, occurs concomitantly with opposite flows of fluid and protein, i.e., from blood to dialysate. However, until now a theoretical explanation of this phenomenon has been lacking. A two-phase distributed model is proposed to explain the bidirectional, concomitant transport of fluid, albumin and glucose through the peritoneal transport system (PTS) during peritoneal dialysis. The interstitium of this tissue is described as an expandable two-phase structure with phase F (water-rich, colloid-poor region) and phase C (water-poor, colloid-rich region) with fluid and solute exchange between them. A low fraction of phase F is assumed in the intact tissue, which can be significantly increased under the influence of hydrostatic pressure and tissue hydration. The capillary wall is described using the three-pore model, and the conditions in the peritoneal cavity are assumed commencing 3 min after the infusion of glucose 3.86% dialysis fluid. Computer simulations demonstrate that peritoneal absorption of fluid into the tissue, which occurs via phase F at the rate of 1.8 ml/min, increases substantially the interstitial pressure and tissue hydration in both phases close to the peritoneal cavity, whereas the glucose-induced ultrafiltration from blood occurs via phase C at the rate of 15 ml/min. The proposed model delineating the phenomenon of concomitant bidirectional transport through PTS is based on a two-phase structure of the interstitium and provides results in agreement with clinical and experimental data. PMID:26945084

  15. Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis.

    Directory of Open Access Journals (Sweden)

    Hsien-Yi Chiu

    Full Text Available The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs modify the risk of cardiovascular disease (CVD in patients with psoriasis remains unknown.Using the Taiwan National Health Insurance Research Database (NHIRD, we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD and stroke between patients with and without SDs.Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22-1.28 and stroke (aHR, 1.24; 95% CI, 1.16-1.33 as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults.The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.

  16. Effects of Treatment Duration During Concomitant Chemoradiation Therapy for Cervical Cancer

    International Nuclear Information System (INIS)

    Purpose: To determine whether extended treatment duration (TD) impacts in-field relapse and survival in the setting of concomitant chemoradiation therapy (CRT) for cervical cancer. Methods and Materials: A total of 480 consecutive cervical cancer patients treated with radiation therapy (RT) alone or concomitant CRT for curative intent were retrospectively analyzed. Relapse was defined as in-field with respect to external beam radiation therapy fields. The effects of TD on in-field relapse, disease-free survival (DFS), and overall survival (OS) rates were assessed continuously and categorically within the separate RT and CRT cohorts. Covariates included age, histology, stage, and cumulative dose to point A. In-field relapse, DFS, and OS rates were estimated with Kaplan-Meier analysis; comparisons used log–rank statistic. Multivariate analysis used the Cox proportional hazards model. Results: A total of 372 patients (RT n=206, CRT n=166) were evaluable, with a median follow-up for relapse-free patients of 4.2 years (RT 4.4 years, CRT 4.2 years; P=.807). Treatment duration was longer in the RT cohort (median 55 days; range 35-99 days) versus the CRT cohort (median 51 days; range 35-92 days) (P=.001). In the RT cohort, TD ≥62 days trended to significance for predicting inferior DFS (hazard ratio 1.42, 95% confidence interval 0.86-1.98, P=.086). However, in the CRT cohort, TD assessed continuously or categorically across multiple cutoff thresholds did not predict for in-field relapse, DFS, or OS. Conclusion: With RT alone, extended TD ≥62 days may adversely impact treatment efficacy. With the addition of concomitant chemotherapy to RT, however, extended TD has no effect on treatment efficacy

  17. Clinical effects of adalimumab treatment with concomitant azathioprine in Japanese Crohn’s disease patients

    Directory of Open Access Journals (Sweden)

    Kumi Ishida

    2013-01-01

    Full Text Available AIM: To assess adalimumab’s efficacy with concomitant azathioprine (AZA for induction and maintenance of clinical remission in Japanese Crohn’s disease (CD patients. METHODS: This retrospective, observational, single-center study enrolled 28 consecutive CD patients treated with adalimumab (ADA. Mean age and mean disease duration were 38.1 ± 11.8 years and 11.8 ± 10.1 years, respectively. The baseline mean Crohn’s disease activity index (CDAI and C-reactive protein were 177.8 ± 82.0 and 0.70 ± 0.83 mg/dL, respectively. Twelve of these patients also received a concomitant stable dose of AZA. ADA was subcutaneously administered: 160 mg at week 0, 80 mg at week 2, followed by 40 mg every other week. Clinical response and remission rates were assessed via CDAI and C-reactive protein for 24 wk. RESULTS: The mean CDAI at weeks 2, 4, 8, and 24 was 124.4, 120.2, 123.6, and 135.1, respectively. The CDAI was significantly decreased at weeks 2 and 4 with ADA and was significantly suppressed at 24 wk with ADA/AZA. Overall clinical remission rates at weeks 4 and 24 were 66.7% and 63.2%, respectively. Although no statistically significant difference in C-reactive protein was demonstrated, ADA with AZA resulted in a greater statistically significant improvement in CDAI at 24 wk, compared to ADA alone. CONCLUSION: Scheduled ADA with concomitant AZA may be more effective for clinical remission achievement at 24 wk in Japanese Crohn’s disease patients.

  18. Adjuvant radiotherapy and concomitant 5-fluorouracil by protracted venous infusion for resected pancreatic cancer

    International Nuclear Information System (INIS)

    Purpose: To assess the toxicity and clinical benefit from adjuvant chemoradiotherapy consisting of protracted venous infusion 5-fluorouracil (5-FU) and concomitant radiotherapy in patients with resected pancreatic cancer. Methods and Materials: Between 1994 and 1999, 52 patients who underwent pancreaticoduodenectomy received adjuvant chemoradiotherapy. The tumor bed and regional nodes received a dose of 45 Gy in fractions of 1.8 Gy followed by boost to the tumor bed if the surgical margins were involved (total dose, 54 Gy). The patients also received concomitant 5-FU by protracted venous infusion (200-250 mg/m2/day, 7 days/week) during the entire radiotherapy course. Results: Fifty-two patients (30 men, 22 women) were enrolled and treated on this protocol. The median age was 63 years (range, 38-78 years), and the median Karnofsky Performance Status was 80 (range, 70-100). Thirty-five percent had involved surgical margins and 59% had involved lymph nodes. All patients completed therapy, and there were no Grade IV/V toxicities observed. With median follow-up of 24 months (range, 3-52 months) for surviving patients, the median survival is 32 months, and 2-year and 3-year survivals are 62%, and 39%, respectively. Conclusion: Radiotherapy with concomitant 5-FU by protracted venous infusion as adjuvant treatment for resected pancreatic cancer is well tolerated. This approach allows for greater dose intensity with reduced toxicity. The median survival of this cohort of patients compares favorably with our earlier experience and other published series.

  19. Concomitant Takayasu arteritis and Cushing syndrome in a child undergoing open adrenalectomy: An anaesthetic challenge

    Directory of Open Access Journals (Sweden)

    Hemlata

    2014-01-01

    Full Text Available Takayasu′s arteritis (TA is a rare, chronic progressive panendarteritis involving the aorta and its main branches. Anaesthesia for patients with TA is complicated by their severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties encountered in monitoring arterial blood pressure. In a patient with Cushing′s syndrome (CS, the anaesthesiologist needs to deal with volume overload, hyperglycaemia, hypokalaemia, difficult airway and ventilation. Anaesthetic management of a patient with concomitant TA and CS undergoing adrenalectomy has hardly ever been reported. We present the successful anaesthetic management of a 15-year-old child with coexisting TA and CS undergoing open adrenalectomy.

  20. Superselective arterial infusion and concomitant radiotherapy for nasal cavity and paranasal sinus cancer

    International Nuclear Information System (INIS)

    Thirty-seven patients with nasal cavity or paranasal sinus cancer received superselective intra-arterial infusion therapy of cisplatin and conventional concomitant extrabeam radiotherapy (RADPLAT). Five-year progression free rate of primary lesion and overall survival were 84% and 73% for all patients, respectively. Acute toxic effects were considered acceptable, however, severe toxic events occurred in some cases, namely, eye problems, tearing, obstructive sinusitis, osteoradionecrosis, and so on. We considered these complications did not severe compared with those of surgery. RADPLAT is considered to be one of the treatments for nasal cavity and paranasal sinus cancer. (author)

  1. Concomitant gastric adenocarcinoma and stromal tumor in a woman with polymyalgia rheumatica

    Institute of Scientific and Technical Information of China (English)

    Panteleimon Kountourakis; Niki Arnogiannaki; Ilias Stavrinides; Nikiforos Apostolikas; Gerasimos Rigatos

    2008-01-01

    Gastrointestinal stromal tumors (GISTs) are rare neoplasms (1%) of the gastrointestinal tract and to our knowledge only rare cases of synchronous presentation of gastric carcinomas and GISTs are reported in the literature.A 72-year-old female with a simultaneous presentation of gastric adenocarcinoma and GIST is presented.Moreover,due to polymyalgia rheumatica the patient received corticosteroids as treatment for the last 3 years.The concomitant occurrence of these neoplasms may involve common carcinogenic factors and there could be an association with polymyalgia rheumatica either as a paraneoplastic presentation or due to its treatment with corticosteroids.

  2. Intrauterine device infection causing concomitant streptococcal toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus bacteraemia.

    Science.gov (United States)

    Wu, Carolyn M Yu; Noska, Amanda

    2016-01-01

    Intrauterine devices (IUDs) are rarely associated with serious infections. We report an unusual concomitant infection of group A Streptococcus (GAS) causing toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus associated with an IUD in a healthy 50-year-old patient. The IUD was subsequently removed and the patient recovered on the appropriate antibiotics. This case highlights the importance of clinicians' high index of suspicion of an IUD infection and prompt removal of the infected foreign body to obtain source control. PMID:26965406

  3. Concomitant laparoendoscopic single-site surgery for ureterolithotomy and contralateral renal cyst marsupialization.

    Science.gov (United States)

    Lee, Joo Yong; Lee, Seung Wook

    2011-01-01

    A 63-year-old woman presented with acute right-flank pain and left-flank pain. Computed tomography identified a right ureter stone and a left renal cyst. The patient underwent concomitant laparoendoscopic single-site surgery (LESS) for ureterolithotomy and renal cyst marsupialization with the use of an Alexis® wound retractor, which was inserted through the umbilical incision. Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports. LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery. PMID:21344033

  4. Concomitant slide tracheoplasty and cardiac operation for congenital tracheal stenosis associated with VACTERL.

    Science.gov (United States)

    Wu, En-Ting; Wang, Ching-Chia; Lin, Ming-Tai; Huang, Pei-Ming; Chen, Shyh-Jye; Huang, Chi-Hsiang; Hwang, Haw-Kwei; Chen, Ming-Ren; Huang, Shu-Chien

    2013-10-01

    The association of congenital tracheal stenosis and tracheoesophageal (TE) fistula is rare. Here, we report 2 patients with tracheobronchial stenosis (complete cartilage ring) involving the lower trachea and right bronchus. Both patients had associated VACTERL (vertebral anomalies, anal atresia, cardiovascular anomalies, TE, renal, and limb defects) congenital cardiac defects and tracheal diverticula after repair of the TE fistula in type C esophageal atresia. The stenotic segment began at the orifice of the TE fistula, which became diverticula after the TE fistula was repaired. Concomitant repair of congenital cardiac defects and a slide tracheoplasty with elimination of the diverticula were performed successfully. PMID:24088476

  5. Analysis of the growth of concomitant nitride layers produced by a post-discharge assisted process

    International Nuclear Information System (INIS)

    In the present work, the growth of concomitant nitride layers during a post-discharge process is studied. The analysis takes into account the similarities and differences between nitriding post-discharge processes and other nitriding processes, employing a mathematical simulation of nitrogen diffusion. The considered differences are related to the thermodynamic standard states, the nitrogen concentration on the surface and the sputtering of the surface (this one for plasma processes). Nitrogen diffusion and layer formation are described from the beginning of the process by means of a mathematical model

  6. Solid pseudopapillary tumor of the pancreas and concomitant urogenital malformations in a young woman.

    Science.gov (United States)

    Guan, Zhi-Wei; Sun, Lu; Wang, Yan-Qiu; Xu, Bai-Xuan

    2013-01-01

    Solid pseudopapillary tumor (SPT) of the pancreas is a rare pancreatic tumor with low malignant potential. It occurs characteristically more often in young women. SPT associated with extra- and pancreatic anomalies are occasionally reported. Here we report a case of pancreatic SPT with concomitant urogenital malformations including solitary kidney and uterus didelphys in a 25-year-old woman. The patient underwent central pancreatectomy, and SPT was confirmed with pathological results. Recurrence or metastasis was not found after 14 months of follow-up. PMID:23445554

  7. Cisplatin or Capecitabine in Combination with Gemcitabine for Patients with Advanced Metastatic Breast Cancer%顺铂或卡培他滨联合吉西他滨治疗晚期转移性乳腺癌

    Institute of Scientific and Technical Information of China (English)

    刘洪; 刘立缔; 彭文剑; 罗伟华

    2015-01-01

    Objective To analyze the efficacy and safety of capecitabine or cisplatin in combination with gemcitabine for patients with advanced metastatic breast cancer. Methods A total of 80 patients with advanced metastatic breast can-cer patients were randomly divided into group A and group B, 40 patients in each group. Group A adopted the therapy of gemcitabine plus cisplatin, and group B adopted the therapy of gemcitabine plus capecitabine. Observed and compared the treatment effectiveness and toxicity between the two groups of patients. Results Group A had a remission rate of 27.5%, but group B had a remission rate of 50.0%. The difference in remission rate was statistically significant between the two groups (P0.05),但 B 组的消化道和血液系统毒副反应均较 A 组轻,差异有统计学意义(P<0.05)。结论吉西他滨联合卡培他滨治疗晚期转移性乳腺癌患者的治疗效果和安全性均优于吉西他滨联合顺铂,值得临床进一步推广应用。

  8. Clinical observation of capecitabine in the maintenance treatment of advanced breast cancer%卡培他滨维持治疗晚期乳腺癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    李剑英; 季从飞; 陈佳; 谭清和

    2014-01-01

    Background and purpose: Capecitabine, which is widely used in the first-line treatment of advanced breast cancer, was known little in the maintenance treatment of advanced breast cancer. The present study aimed to explore the efficacy and safety of capecitabine in the maintenance treatment of advanced breast cancer. Methods: A total of 62 advanced breast cancer patients confirmed by histopathology and/or cytology, who had been evaluated as CR/PR/SD after first-line treatment, were divided into two groups. Thirty-one of them received capecitabine orally as maintenance treatment, while the others were followed up without any treatment. The clinical response was evaluated every two cycles. Results:The median time to progression (TTP) of the capecitabine group was 12 (2-24) months, which was signiifcantly higher than the control group. In the subgroup analysis, similar results were detected in the premenopausal group, hormone receptor positive group, HER-2 positive group, metastasis group, no capecitabine used history group. Among the capecitabine group,the overall response rate (CR+PR) was 19.4%, and the disease control rate (CR+PR+SD) was 74.2%. The most common adverse effects were hand-foot syndrome, hematologic toxicity and gastrointestinal reaction, all of which could be tolerated. The overall score of the capecitabine group evaluated by the Chinese vesion of the FACT-B was signiifcantly higher than the control group. Conclusion:Capecitabine can effectively and tolerably prolong survival time and improve the quality of life of patients in the maintenance treatment of advanced breast cancer.%背景与目的:卡培他滨是晚期乳腺癌一线治疗方案用药,但在晚期乳腺癌的维持治疗中的研究较少。本文旨在探讨卡培他滨维持治疗晚期乳腺癌的疗效及不良反应。方法:将一线化疗后处于完全缓解(complete response,CR)、部分缓解(partial response,PR)或疾病稳定(stable disease,SD)的62例患者分为2

  9. Capecitabine plus cisplatin treatment in patients with advanced hepatocellular carcinoma%进展期肝细胞癌患者的卡培他滨加顺铂的联合治疗

    Institute of Scientific and Technical Information of China (English)

    Manal M Abdel Wahab; Lobna R Ezz Elarab; Mohamed A Ezz Elarab

    2010-01-01

    Objective:Hepatocellular carcinoma(HCC)is the sixth most common cancer in the wodd and the third leading cause of cancer related death globally.Parentral treatment of Egyptian patients of bilharziasis contributed to the high incidence of viral hepatitis,and subsequently liver cirrhosis and HCC.Capecitabine plus cisplatin protocol was evaluated regarding the efficacy and safety in patients with advanced HCC as first line chemotherapy.Methods:One hundred patients trial).Results:Baseline characteristics were comparable in beth groups.According to Barcelona Clinic Liver Cancer Staging System,stage C was the most predominant(82% vs.75%)in both groups.Median OS was 12 months versus 10 months in favor of the treated group(P value <0.05).Median TTP was significantly higher in the chemotherapy group(7 months vs.4.5 months)as well as disease control rate(40% vs.29%),no patient had achieved complete response.Grade 3 toxicity was more pronounced in the treatment group,as regards vomiting and diarrhea(10% vs.2%),neurotoxicity(6% vs.2%),elevation of aminotransferase and bilirubin(9.8% vs.4.9%),hand and foot syndrome reaction was recorded only in chemotherapy group.Conclusion:Capecitabine plus cisplatin regimen showed modest antitumor activity with tolerable toxicity in patients with advanced HCC.Moreover,because of the significantly prolonged time to progression,we demand further attention to this convenient,outpatient,and economic profile based chemotherapy protocol.

  10. Phase I trial of concomitant hyperfractionated radiotherapy with docetaxel and cisplatin for locally advanced head and neck cancer

    OpenAIRE

    Allal, Abdelkarim Said; Zwahlen, Daniel; Becker, Minerva; Dulguerov, Pavel; Mach, Nicolas

    2006-01-01

    This study was conducted to determine the maximum tolerated dose of docetaxel when administered concomitantly with radical hyperfractionated radiotherapy and cisplatin in patients with locally advanced head and neck cancer.

  11. Concomitant chemo-radiotherapy for the locally advanced rectum cancer; Chimioradiotherapie concomitante dans le cancer du rectum localement evolue

    Energy Technology Data Exchange (ETDEWEB)

    Haoui, M.; Aksil, N.; Boualga, K.; Moussaoui, D.; Ladj, O. [Service de radiotherapie-oncologie, centre anti-cancer, Blida (Algeria)

    2010-10-15

    The authors report a retrospective study which aimed at assessing the use of a concomitant chemo-radiotherapy, its tolerance and its feasibility in the case of a locally advanced rectum cancer. Based on data obtained among 62 patients presenting a rectum cancer, they analyse the results in terms of tolerance (cases of leukopenia, anemia, diarrhea, radiodermatitis), of relapses, and survival. Toxicity is acceptable and the concomitant treatment renders the tumour operable in many cases. Short communication

  12. Therapeutic efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease

    OpenAIRE

    Ya-mei RAN; Lin, Ling; Yu-qin HE; Chen, Qiang; Ji, Lei; Xiu-qiong LANG; Huang, Zhi-yong; YANG, MIN

    2015-01-01

    Objective To study the clinical efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease, and its effects on mental health and life-quality of the patients. Methods According to the Rome Ⅲ criteria and Montreal consensus in diagnosis of gastroesophageal reflux disease, 50 patients with concomitant refractory functional dyspepsia and non-erosive reflux disease were recruited. The clinical efficacy of digital music gastr...

  13. Pattern of midface trauma with associated concomitant injuries in a Nigerian Referral Centre

    Directory of Open Access Journals (Sweden)

    Samuel Udeabor

    2014-01-01

    Full Text Available Aim: The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. Methodology: This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio-demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. Results: A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20-29 year age group was mostly affected (44.6% and the most common cause of midface injuries was road traffic accident (91.1%. The zygoma was fractured more than any other midfacial bone (46.0%. A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34% and 35 (24.3% respectively. The patients were mostly treated conservatively or by closed reduction. Conclusion: The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.

  14. Dosing Recommendations for Concomitant Medications During 3D Anti-HCV Therapy.

    Science.gov (United States)

    Badri, Prajakta S; King, Jennifer R; Polepally, Akshanth R; McGovern, Barbara H; Dutta, Sandeep; Menon, Rajeev M

    2016-03-01

    The development of direct-acting antiviral (DAA) agents has reinvigorated the treatment of hepatitis C virus infection. The availability of multiple DAA agents and drug combinations has enabled the transition to interferon-free therapy that is applicable to a broad range of patients. However, these DAA combinations are not without drug-drug interactions (DDIs). As every possible DDI permutation cannot be evaluated in a clinical study, guidance is needed for healthcare providers to avoid or minimize drug interaction risk. In this review, we evaluated the DDI potential of the novel three-DAA combination of ombitasvir, paritaprevir, ritonavir, and dasabuvir (the 3D regimen) with more than 200 drugs representing 19 therapeutic drug classes. Outcomes of these DDI studies were compared with the metabolism and elimination routes of prospective concomitant medications to develop mechanism-based and drug-specific guidance on interaction potential. This analysis revealed that the 3D regimen is compatible with many of the drugs that are commonly prescribed to patients with hepatitis C virus infection. Where interaction is possible, risk can be mitigated by paying careful attention to concomitant medications, adjusting drug dosage as needed, and monitoring patient response and/or clinical parameters. PMID:26330025

  15. Radiochemoimmunotherapy with intensity-modulated concomitant boost: interim analysis of the REACH trial

    Directory of Open Access Journals (Sweden)

    Jensen Alexandra D

    2012-04-01

    Full Text Available Abstract Purpose To evaluate efficacy and toxicity clinical in the intensified treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN with the combination of chemotherapy, the EGFR antibody cetuximab, and intensity-modulated radiation therapy (IMRT in a concomitant boost concept. Methods REACH is a prospective, bi-centric phase II trial of carboplatin/5-FU and cetuximab weekly combined with IMRT. Primary endpoint is locoregional control, secondary endpoints include acute radiation effects and adverse events. Evaluation of disease response is carried out according to the Response Evaluation Criteria in Solid Tumors (RECIST; toxicity is assessed using NCI CTC v 3.0. Results Treatment was tolerated moderately well, acneiforme erythema occurred in 74.1% (grade II/III, mucositis grade III in 28.6%, and radiation dermatitis grade III in 14.3%. Higher-grade side-effects resolved quickly until the first follow-up post treatment. Objective response rates were promising with 28.6% CR at first follow-up and 92.9% thereafter. Conclusion The combination of standard carboplatin/5-FU and cetuximab is feasible and results in promising objective response rates. The use of an IMRT concomitant boost is practicable in a routine clinical setting resulting in only moderate overall toxicity of the regimen. Trial Registration Number ISRCTN87356938.

  16. Radiochemoimmunotherapy with intensity-modulated concomitant boost: interim analysis of the REACH trial

    International Nuclear Information System (INIS)

    To evaluate efficacy and toxicity clinical in the intensified treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) with the combination of chemotherapy, the EGFR antibody cetuximab, and intensity-modulated radiation therapy (IMRT) in a concomitant boost concept. REACH is a prospective, bi-centric phase II trial of carboplatin/5-FU and cetuximab weekly combined with IMRT. Primary endpoint is locoregional control, secondary endpoints include acute radiation effects and adverse events. Evaluation of disease response is carried out according to the Response Evaluation Criteria in Solid Tumors (RECIST); toxicity is assessed using NCI CTC v 3.0. Treatment was tolerated moderately well, acneiforme erythema occurred in 74.1% (grade II/III), mucositis grade III in 28.6%, and radiation dermatitis grade III in 14.3%. Higher-grade side-effects resolved quickly until the first follow-up post treatment. Objective response rates were promising with 28.6% CR at first follow-up and 92.9% thereafter. The combination of standard carboplatin/5-FU and cetuximab is feasible and results in promising objective response rates. The use of an IMRT concomitant boost is practicable in a routine clinical setting resulting in only moderate overall toxicity of the regimen.

  17. Comparison of three concomitant boost techniques for early-stage breast cancer

    International Nuclear Information System (INIS)

    Purpose: Whole breast radiotherapy (RT) followed by a tumor bed boost typically spans 5-6 weeks of treatment. Interest is growing in RT regimens, such as concomitant boost, that decrease overall treatment time, lessening the time/cost burden to patients and facilities. Methods and Materials: Computed tomography (CT) scans from 20 cases were selected for this retrospective, dosimetric study to compare three different techniques of concomitant boost delivery: (1) standard tangents plus an electron boost (2) intensity-modulated RT (IMRT) tangents using custom compensators plus an electron boost, and (3) IMRT tangents plus a conformal photon boost. The equivalent uniform dose model was used to compare the plans. Results: The average breast equivalent uniform dose value for the three techniques (standard, IMRT plus electrons, and IMRT plus photons) was 48.6, 47.9, and 48.3, respectively. The plans using IMRT more closely approximated the prescribed dose of 46 Gy to the whole breast. The breast volume receiving >110% of the dose was less with the IMRT tangents than with standard RT (p 0.037), but no significant difference in the maximal dose or other evaluated parameters was noted. Conclusion: Although the IMRT techniques delivered the prescribed dose with better dose uniformity, the small improvement seen did not support a goal of improved resource use

  18. Pancreatic metastasis of Merkel cell carcinoma and concomitant insulinoma: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Hartschuh Wolfgang

    2005-09-01

    Full Text Available Abstract Background Merkel cell carcinomas are rare neoplasm of neuroendocrine origin, usually observed in elderly people in areas with abundant sunlight, and predominantly located on the head and neck, extremities, and trunk. In many patients, a local recurrence after resection of the primary tumour and even distant metastases can be found. Case presentation We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma. An 82-year old lady suffered from recurrent attacks of hypoglycemia and presented with an abdominal mass, 2 years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma. An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out. Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail, in the peripancreatic tissue and in the surrounding soft tissue consistent with metastatic Merkel cell carcinoma in addition to an insulinoma of the pancreatic body. Conclusion This is the first documented case of a metastatic Merkel cell carcinoma and a concomitant insulinoma, suggesting either a mere coincidence or an unknown neuroendocrine tumor syndrome.

  19. Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients

    International Nuclear Information System (INIS)

    Coronary heart disease (CHD) patients often show atherosclerotic vascular disease in other vascular territories. We evaluated how often whole-body MR imaging detects concomitant arterial pathologies in CHD patients, and how often these pathologies were not known to the patients previously. Of 4,814 participants in the population-based Heinz Nixdorf Recall Study, 327 reported CHD (i.e., previous coronary bypass surgery, angioplasty); of those, 160 patients (mean age 66.4 years) were examined using MR of the brain, the heart (excluding the coronary arteries), and whole-body MR angiography. The prevalence of each vascular pathology was assessed, correlated to the others and compared to patients' histories. Of the 160 CHD patients, 16 (10%) showed MR signs of stroke, and 77 (48.1%) had a stenosis >50% in at least one extracerebral peripheral artery (other than the coronaries), including 28 (17.5%) with relevant renal artery stenoses, and 20 (12.5%) with relevant extracerebral internal carotid artery stenoses. False negative histories were reported in 12 of 81 cases with myocardial infarctions, and in 11 of 16 cases with cerebrovascular infarctions. This whole-body atherosclerosis MR screening program allows previously unknown concomitant vascular disease to be detected in coronary heart disease patients. Its prospective value should be assessed in further studies. (orig.)

  20. Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients

    Energy Technology Data Exchange (ETDEWEB)

    Ladd, Susanne C.; Nuefer, Michael; Gizewski, Elke; Wanke, Isabel; Ladd, Mark E.; Forsting, Michael [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Stang, Andreas [Martin-Luther University, Medical Faculty, Institute of Medical Epidemiology, Biometry and Informatics, Halle-Wittenberg (Germany); Bromen, Katja [DG INFSO, European Commission, Brussels (Belgium); Moebus, Susanne; Joeckel, Karl-Heinz [University Hospital, Institute of Medical Informatics, Biometry and Epidemiology, Essen (Germany); Doerfler, Arnd [University of Erlangen Medical School, Department of Neuroradiology, Erlangen (Germany); Benemann, Jens [University Hospital, Department of Neurology, Essen (Germany); Erbel, Raimund; Schmermund, Axel [University Hospital, Department of Cardiology, Essen (Germany)

    2007-04-15

    Coronary heart disease (CHD) patients often show atherosclerotic vascular disease in other vascular territories. We evaluated how often whole-body MR imaging detects concomitant arterial pathologies in CHD patients, and how often these pathologies were not known to the patients previously. Of 4,814 participants in the population-based Heinz Nixdorf Recall Study, 327 reported CHD (i.e., previous coronary bypass surgery, angioplasty); of those, 160 patients (mean age 66.4 years) were examined using MR of the brain, the heart (excluding the coronary arteries), and whole-body MR angiography. The prevalence of each vascular pathology was assessed, correlated to the others and compared to patients' histories. Of the 160 CHD patients, 16 (10%) showed MR signs of stroke, and 77 (48.1%) had a stenosis >50% in at least one extracerebral peripheral artery (other than the coronaries), including 28 (17.5%) with relevant renal artery stenoses, and 20 (12.5%) with relevant extracerebral internal carotid artery stenoses. False negative histories were reported in 12 of 81 cases with myocardial infarctions, and in 11 of 16 cases with cerebrovascular infarctions. This whole-body atherosclerosis MR screening program allows previously unknown concomitant vascular disease to be detected in coronary heart disease patients. Its prospective value should be assessed in further studies. (orig.)

  1. Simultaneous radiochemotherapy versus concomitant boost radiation for advanced inoperable head and neck cancer

    International Nuclear Information System (INIS)

    In this prospective, non-randomized study we compare the results of simultaneous radiochemotherapy (RCT) with those of concomitant boost treatment (CBT) in advanced head and neck cancer. From January 1993 to March 1999, 77 patients were treated with cisplatin, 5-FU, and 70.2 Gy (accelerated split-course); from January 1995 to March 1999, a further 33 patients received CBT to a total dose of 72 Gy. Toxicities were prospectively recorded according to RTOG/EORTC criteria. Acute and subacute reactions did not differ significantly. Severe late effects (III/IV) remained anecdotal (one fistula). Therapy-associated mortalities were 3%(RCT) vs. 0% (CBT), most tumors responding well to therapy (CR + PR: RCT: 72%, CBT: 63%). The 2-year probabilities for freedom from locoregional progression amounted to 42% (RCT) and 31% (CBT); p > 0.05. Tumor-specific 2-year survival amounted to 40% (RCT) and 34% (CBT); p > 0.05. Both of the treatment concepts yield high remission rates with moderate toxicities. Nevertheless, median time to recurrence is still fairly short. We could not find any differences for local control and survival. For patients who are not able to complete the full three courses of radiochemotherapy, the concomitant boost schedule presents a good alternative

  2. Concomitant Radiotherapy and Chemotherapy for High-Risk Nonmelanoma Skin Carcinomas of the Head and Neck

    Directory of Open Access Journals (Sweden)

    Smith Apisarnthanarax

    2011-01-01

    Full Text Available Background. To report on the use and feasibility of a multimodality approach using concomitant radiotherapy and chemotherapy in patients with high-risk nonmelanoma skin carcinoma (NMSC of the head and neck. Methods. Records of patients with NMSC of the head and neck who received concomitant CRT at the University of North Carolina between 2001 and 2007 were reviewed. Results. Fifteen identified patients had at least one of the following high-risk factors: T4 disease (93%, unresectability (60%, regional nodal involvement (40%, and/or recurrence (47%. Ten patients were treated in the definitive setting and five in the postoperative setting. Platinum based chemotherapy was given in 14 (93% patients. Ten of fifteen (67% patients completed all planned chemotherapy treatments, and thirteen patients (87% completed at least 80% of planned chemotherapy. Mild radiation dermatitis occurred in all patients and reached grade 3 in 13% of patients. No patients experienced grade 4 or 5 toxicity. With a median followup of 31 months in surviving patients, the 2-year actuarial locoregional control and relapse-free survival were 79% and 49%, respectively. Conclusions. Definitive or postoperative chemoradiotherapy for patients with locally advanced or regionally metastasized NMSC of the head and neck appears feasible with acceptable toxicities and favorable locoregional control.

  3. Superselective arterial infusion and concomitant radiotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Superselective arterial infusion for patients with advanced head and neck cancer has increasingly been applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Forty-four patients, who were considered contraindicated for surgery or rejected radical surgery, received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). During the median follow-up period of 17 months, 2-year progression-free survival rate of primary lesion was 66.9%, and that of patients with T4b diseases 57%. The 2-year overall survival rate was 52.4%. Although acute toxic effects were considered acceptable, severe toxic events occurred in some cases, namely, cranial nerve palsy, Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, sepsis, and osteoradionecrosis. We confirmed the high effectiveness of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of decadose cisplatin on locoregional disease. Moreover, even patients with unresectable disease can be cured. We must clarify the treatment results and late side effects, and establish the indications for this treatment. (author)

  4. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  5. Biological removal of pharmaceutical compounds using white-rot fungi with concomitant FAME production of the residual biomass.

    Science.gov (United States)

    Vasiliadou, I A; Sánchez-Vázquez, R; Molina, R; Martínez, F; Melero, J A; Bautista, L F; Iglesias, J; Morales, G

    2016-09-15

    The efficiency of two white-rot fungi (WRF), Trametes versicolor and Ganoderma lucidum, to eliminate thirteen pharmaceutical pollutants with concomitant biodiesel production from the accumulating lipid content after treatment, was examined. The removal efficiency was studied using both individual and combined strains. The results of individual and combined strains showed a total removal (100%) of diclofenac (DCF), gemfibrozil (GFZ), ibuprofen (IBP), progesterone (PGT) and ranitidine (RNT). Lower removals were achieved for 4-acetamidoantipyrin (AAA), clofibric acid (ACF), atenolol (ATN), caffeine (CFN), carbamazepine (CZP), hydrochlorothiazide (HCT), sulfamethoxazole (SMX) and sulpiride (SPD), although the combination of both strains enhanced the system's efficiency, with removals ranging from 15 to 41%. This increase of the removal efficiency when combining both strains was attributed to the interactions developed between them (i.e., competition). Results from enzymatic and cytochrome P450 examination suggested that both extracellular (laccase, MnP, LiP) and intracellular oxidation mechanisms participate in the biological removal of pharmaceuticals. On the other hand, the "green" potential of the fungal sludge generated during the biological removal process was assessed for biodiesel production by means of one-step direct (in-situ) transformation. This process consists of the simultaneous extraction and conversion of lipids contained in the sludge by catalytic esterification/transesterification using a robust acid heterogeneous Zr-SBA-15 catalyst. This catalytic system provided conversions close to 80% of the saponifiable fraction (including free fatty acids and glycerides) in the presence of high amount of impurities. The overall weight FAME yield, based on the initial dried mass, was close to 30% for both strains. PMID:27233048

  6. Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: A multicentric Study-ISO-AIMS study

    Directory of Open Access Journals (Sweden)

    Omprakash Heggadahalli Mahadevappa

    2016-01-01

    Full Text Available Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications. Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin. Materials and Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included[1] 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels;[2] 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery;[3] 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction;[4] 1 session of electrosurgery. Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15. Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised.

  7. Two-stage total hip arthroplasty for complex pelvic abnormalities: Example of hip arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union.

    Science.gov (United States)

    Jacquot, A; Goetzmann, T; Jullion, S; Sirveaux, F; Molé, D; Roche, O

    2016-06-01

    Hip prosthesis implantation requires a stable pelvic foundation, which may be lacking in patients with complex pelvic abnormalities (e.g., arthrodesis conversion, tumour excision, or revision with large bony defects). Many reconstructive options exist for these situations, but their outcomes vary with the initial amount of bone loss and with the technique used. We describe a two-stage arthroplasty technique (acetabular cup first, then femoral stem) and report its use in a case of arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union. Clinical and radiological outcomes after 5 years are reported. This procedure can be adapted to the most complex cases of pelvic reconstruction. PMID:27052938

  8. Short-term Effect of Chemotherapy Concomitant with Multiple Autologous Immunocytes on Patients with Colorectal Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Liu Junquan; Zhu Yun; Zhang Nanzheng; Chen Fuxing; Chen Ling; Zhang Song; Yang Wanying; Zhou Zhonghai; Lv Xiaoting

    2013-01-01

    Objective:To compare the differences of cellular immunological functional changes and survival time of chemotherapy concomitant with multiple autologous immunocytes with single chemotherapy on patients with colorectal carcinoma (CRC). Methods: Of the 83 CRC patients, 43 were treated with single chemotherapy (single chemotherapy group) while the other 40 were given chemotherapy concomitant with multiple autologous immunocytes (combined chemotherapy group). Blood cell separator was applied to collect autologous peripheral blood mononuclear (PBMC) which was used to induce the cultures of peripheral blood CD3AK cell, CIK cell, dendritic cell (DC), γδT cell and NK cell based on routine approaches. Peripheral blood CD3+, CD4+, CD8+, CD19+, CD16+, CD56+, CD4/CD8 andγδT cell ratio as well as the positive expression rates of perforin, granular enzyme B and CD107a in PBMC were determined by lfow cytometer. Same chemotherapy (oxaliplatin + CF + 5-FU) was intravenously given to both groups, while in combination group, 4, 6, 9, 11 and 10 patients received 3, 6, 7, 10 and>16 courses of treatment, respectively. Results:Subgroup of immunocytes and absolute value in combined chemotherapy group were evidently higher than in single chemotherapy group, but there was no significant difference in Karnofsky score. In addition, combined chemotherapy group was apparently higher after treatment than treatment before and single chemotherapy group in the results of perforin, granular enzyme B (GranB) and CD107a in PBMC. Additionally, 1-, 2- and 5-year survival rates in combined chemotherapy group (in phases Ⅱ, Ⅲand Ⅳ) were 70.0%(28/40), 20.0%(8/40) and 10.0%(4/40), higher than those in single chemotherapy group [23.2% (10/43), 7.0% (3/43) and 4.6%(2/43)], respectively, in which the differences in phases Ⅱand Ⅲwere more signiifcant (P Conclusion:Chemotherapy concomitant with multiple autologous immunocytes can improve the immunological function and prolong survival time for

  9. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease?

    Science.gov (United States)

    Zhu, Tie-Yuan; Wang, Jian-Gang; Meng, Xu

    2015-01-01

    A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences

  10. Clinical features of Crohn disease concomitant with ankylosing spondylitis: A preliminary single-center study.

    Science.gov (United States)

    Liu, Song; Ding, Jie; Wang, Meng; Zhou, Wanqing; Feng, Min; Guan, Wenxian

    2016-07-01

    Extraintestinal manifestations (EIMs) cause increased morbidity and decreased quality of life in Crohn disease (CD). Ankylosing spondylitis (AS) belongs to EIMs. Very little is known on the clinical features of CD concomitant with AS. This study is to investigate the clinical features of CD patients with AS.We retrospectively collected all CD patients with AS in our hospital, and established a comparison group (CD without AS) with age, sex, and duration of Crohn disease matched. Clinical information was retrieved for comparison.Eight CD + AS patients were identified from 195 CD patients. Sixteen CD patients were randomly selected into comparison group. All CD + AS patients were male, HLA-B27 (+), and rheumatoid factor (-) with an average age of 40.8 ± 4.52 years. Significant correlation between disease activity of CD and AS was revealed (r = 0.857, P = 0.011). Significant correlation between disease activity of CD and functional limitation associated with AS was identified (r = 0.881, P < 0.01). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and globulin were positively correlated to Crohn disease activity index (CDAI), Bath AS disease activity index, and Bath AS functional index(BASFI) scores (r = 0.73-0.93, P < 0.05). Albumin was negatively associated with CDAI and BASFI (r = -0.73 to -0.91, P < 0.05). The ratio of albumin to globulin (Alb/Glo) was significantly related to all 3 scores (r = -0.81 to -0.91, P < 0.05).Male predominance with a 4.12% concomitant incidence of AS is observed in CD patients. Disease activity of CD correlates with disease activity of AS and functional limitation caused by AS. CRP, ESR, and Alb/Glo may serve as biomarkers for disease activity and functional limitation in CD patients concomitant with AS, although future studies are expected. PMID:27428240

  11. Short-term Effect of Chemotherapy Concomitant with Multiple Autologous Immunocytes on Patients with Colorectal Carcinoma

    Directory of Open Access Journals (Sweden)

    Junquan Liu

    2013-12-01

    Full Text Available Objective: To compare the differences of cellular immunological functional changes and survival time of chemotherapy concomitant with multiple autologous immunocytes with single chemotherapy on patients with colorectal carcinoma (CRC. Methods: Of the 83 CRC patients, 43 were treated with single chemotherapy (single chemotherapy group while the other 40 were given chemotherapy concomitant with multiple autologous immunocytes (combined chemotherapy group. Blood cell separator was applied to collect autologous peripheral blood mononuclear (PBMC which was used to induce the cultures of peripheral blood CD3AK cell, CIK cell, dendritic cell (DC, γδT cell and NK cell based on routine approaches. Peripheral blood CD3+, CD4+, CD8+, CD19+, CD16+, CD56+, CD4/CD8 and γδT cell ratio as well as the positive expression rates of perforin, granular enzyme B and CD107a in PBMC were determined by flow cytometer. Same chemotherapy (oxaliplatin + CF + 5-FU was intravenously given to both groups, while in combination group, 4, 6, 9, 11 and 10 patients received 3, 6, 7, 10 and > 16 courses of treatment, respectively. Results: Subgroup of immunocytes and absolute value in combined chemotherapy group were evidently higher than in single chemotherapy group, but there was no significant difference in Karnofsky score. In addition, combined chemotherapy group was apparently higher after treatment than treatment before and single chemotherapy group in the results of perforin, granular enzyme B (GranB and CD107a in PBMC. Additionally, 1-, 2- and 5-year survival rates in combined chemotherapy group (in phases Ⅱ , Ⅲ and Ⅳ were 70.0% (28/40, 20.0% (8/40 and 10.0% (4/40, higher than those in single chemotherapy group [23.2% (10/43, 7.0% (3/43 and 4.6% (2/43], respectively, in which the differences in phases Ⅱ and Ⅲ were more significant (P <0.05, but no difference was observed between two groups in 5-year survival rate in patients in phase Ⅳ . Conclusion

  12. Efficacy Observation of Capecitabine Combined with Cisplatin in the Treatment of Advanced Triple Negative Breast Cancer%卡培他滨联合顺铂治疗晚期三阴性乳腺癌的疗效观察

    Institute of Scientific and Technical Information of China (English)

    丛雪; 王亚帝; 哈敏文; 刘维

    2012-01-01

    OBJECTIVE: To observe efficacy and toxic side effect of capecitabine combined with cisplatin in the treatment of triple negative advanced breast cancer of negative ER, PR, HER-2. METHODS: 48 cases were diagnosed as advanced metastatic breast cancer of negative ER, PR, HER-2 by immunohistochemistry, among which 24 cases received oral dose of capecitabine 2 500 mg·m-2 alone morning and night for consecutive 14 days, 21 days for the 1 cycle; other 24 cases received capecitabine combined with cisplatin DDP: intravenous infusion of 30 cisplatin mg·m-2, d1~d3, oral dose of capecitabine in 1 250 mg·m-2 morning and night for consecutive 14 days, 21 days for the 1 cycle. The number of completed treatment course in monotherapy group and chemotherapy group were (4.2 + 0.9) and (4.0 + 0.7). RESULTS:The effective rates of capecitabine monotherapy group and chemotherapy group were 29.2% and 33.4%. The median TTP of 24 patients in monotherapy group was 5 months with 1 year survival rate of 65.7%. The median TTP of 24 patients in chemotherapy group was 6 months with 1 year survival rate of 67.7%. The Ⅲ -degree hand-foot syndrome of capecitabine monotherapy group was slightly more than combination group. Toxic side effect of chemotherapy group were mainly gastrointestinal tract reaction, leucopenia, fatigue, etc., and all recovered after proper treatment. CONCLUSION: Capecitabine combined with cisplatin have good efficacy in the treatment of advanced metastatic triple negative breast cancer patients, and toxic side effects can be tolerated.%目的:观察卡培他滨联合顺铂治疗雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)均阴性(三阴性)晚期乳腺癌的疗效与毒副反应.方法:48例经免疫组化证实ER、PR、HER-2阴性的晚期转移性乳腺癌患者,其中24例患者单用卡培他滨2500mg·m-2,分早晚两次口服,连服14d,21d为1个周期;24例患者接受卡培他滨+顺铂方案:顺铂30mg·m-2静脉滴注,d1

  13. An unusual case of spinal cord compression from concomitant spinal epidural lipomatosis and Hodgkin's lymphoma

    Science.gov (United States)

    Ahmadzai, Hasib; Khalil, Ali; Mitchell, Ruth A.; Kwok, Bernard

    2016-01-01

    Spinal epidural lipomatosis (SEL) results from an abnormal accumulation of unencapsulated fat within the epidural space and is a rare cause of spinal cord compression, which needs to be considered with a high index of suspicion. It most commonly occurs secondary to chronic corticosteroid use and endocrinopathies. Idiopathic cases are highly associated with obesity. We report an unusual case of idiopathic thoracic SEL in a 69-year-old male, with an adjacent infiltrative Hodgkin's lymphoma and associated vertebral crush fracture, which resulted in ataxia and sensory loss. Magnetic resonance imaging scans displayed extensive SEL and an infiltrative disease process causing thoracic cord compression. Surgical decompression confirmed the presence of extensive epidural lipomatosis and Hodgkin's lymphoma and subsequently led to improvement in neurological symptoms. To our knowledge, this is the first reported case of concomitant SEL with an adjacent Hodgkin's lymphoma resulting in cord compression. PMID:26962199

  14. Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

    Directory of Open Access Journals (Sweden)

    Berna Dilbaz

    2014-01-01

    Full Text Available A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach.

  15. Acute Concomitant Anterior Cruciate Ligament and Patellar Tendon Tears in a Non-dislocated Knee

    Directory of Open Access Journals (Sweden)

    Robert D Wissman

    2012-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are common and may occur in isolation or with other internal derangements of the joint. Tears of the patellar tendon (PT occur less frequently and are rarely associated with intra-articular pathology. Acute combined tears of both the ACL and PT are known complications of high-energy traumatic knee dislocations. We present a case of an acute concomitant ACL and PT tears in a low-energy non-dislocated knee. To our knowledge, this injury has only been described in a limited number of case reports in the orthopedic literature. We present the imaging findings of this combined injury and discuss the importance of magnetic resonance (MR in diagnosis.

  16. A Case of Turner Syndrome with Concomitant Transient Hypogammaglobulinaemia of Infancy and Central Diabetes Insipidus

    Science.gov (United States)

    Korkmaz, Hüseyin Anıl; Özkan, Behzat; Hazan, Filiz; Büyükinan, Muammer; Çelik, Tanju

    2013-01-01

    Turner syndrome (TS) is a genetic disorder that affects development in females and is characterized by the complete or partial absence of the second sex chromosome, or monosomy X. TS is associated with abnormalities in lymphatic and skeletal development, in growth, and in gonadal function. Cardiac and renal malformations and a number of specific cognitive findings may also be encountered in these patients. An increased risk for hypothyroidism, sensorineural hearing loss, hypertension, and other problems has also been reported. We present the case of a patient with TS accompanied by transient hypogammaglobulinaemia of infancy (THI) and central diabetes insipidus, which we believe is the first reported TS patient with these concomitant disorders. Conflict of interest:None declared. PMID:23419422

  17. Simulation of concomitant magnetic fields on fast switched gradient coils used in advanced application of MRI

    Science.gov (United States)

    Salinas-Muciño, G.; Torres-García, E.; Hidalgo-Tobon, S.

    2012-10-01

    The process to produce an MR image includes nuclear alignment, RF excitation, spatial encoding, and image formation. To form an image, it is necessary to perform spatial localization of the MR signals, which is achieved using gradient coils. MRI requires the use of gradient coils that generate magnetic fields, which vary linearly with position over the imaging volume. Safety issues have been a motivation to study deeply the relation between the interaction of gradient magnetic field and the peripheral nerve stimulation. In this work is presented a numerical modeling between the concomitant magnetic fields produced by the gradient coils and the electric field induced in a cube with σ conductivity by the gradient field switching in pulse sequences as Eco planar Imaging (EPI), due to this kind of sequence is the most used in advance applications of magnetic resonance imaging as functional MRI, cardiac imaging or diffusion.

  18. Concomitance of cervical intramedullary traumatic neuroma and cervical cord herniation in a tetraplegic woman.

    Science.gov (United States)

    Su, Hui-Yi; Wu, Yung-Tsan; Liu, Ming-Ying; Lin, Yu-Chun; Chu, Heng-Yi; Chang, Shin-Tsu

    2013-01-01

    We present the first case of concomitant intramedullary traumatic neuroma and spinal cord herniation. A 57-year-old woman injured her cervical spine with subluxation and cord compression at the C5-C6 level. After the operation, the patient received intensive rehabilitation for one year with well response. Unfortunately, she experienced weakness and progressive numbness extending to all the limbs later. Cervical magnetic resonance imaging revealed spinal cord herniation at the C5-C6 level and pathology proved intramedullary traumatic neuroma. After the second operation, the paresthesia over the trunk and limbs persisted, and the patient was nearly totally assisted in her activities of daily living. The intramedullary traumatic neuroma and spinal cord herniation are rare causes in patients with spinal cord dysfunction. The case presented here indicates the possibility of the coexisting conditions leading to progressive neurologic deficits in patients with old spinal cord injury. PMID:23887176

  19. Concomitant Aspergillus Species Infection and Squamous Cell Carcinoma Diagnosed on Pap Smear.

    Science.gov (United States)

    Gupta, Prajwala; Goyal, Snigdha; Kaushal, Manju

    2016-01-01

    Concomitant infection with Aspergillus species and cervical squamous cell carcinoma in the female genital tract is a rare occurrence and attributed to the opportunistic nature of infection in the immunocompromised state due to the underlying malignancy. The contamination of smears with Aspergillus species should be excluded. The diagnosis of Aspergillus species infection along with squamous cell carcinoma was established on cervicovaginal pap smears in a 62-year-old female presented to gynecological clinic with complaints of stress urinary incontinence. Speculum examination revealed first-degree cervical descent. Smears showed features of squamous cell carcinoma along with fungal spores and fruiting body with hyphae of Aspergillus species. The presence of fruiting bodies and hyphae of Aspergillus species with coexisting squamous cell carcinoma is rare in routine pap smears. True infection needs to be distinguished from contamination by Aspergillus species. Early diagnosis can be established on routine cervicovaginal Pap smear examination. PMID:24272933

  20. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    Science.gov (United States)

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

  1. Concomitant solitary median maxillary central incisor and fused right mandibular incisor in primary dentition

    Directory of Open Access Journals (Sweden)

    G Shilpa

    2012-01-01

    Full Text Available Solitary median maxillary central incisor (SMMCI is a unique developmental anomaly in primary dentition. It involves central incisor tooth germs and may or may not be associated with other anomalies. Its presence, concomitant with fusion of right mandibular incisors has not previously been reported. A 5-year-old girl was presented with a single symmetrical primary maxillary incisor at the midline, with the absence of labial frenulum, an indistinct philtrum and a prominent midpalatal ridge. There was an associated fused tooth in the right incisor region and radiographic examination confirmed only one maxillary central incisor in both the dentitions. Family history revealed that the father of the girl also had a similar anomaly providing probable evidence of etiological role for heredity in SMMCI.

  2. Safety of Grass Pollen Sublingual Immunotherapy for Allergic Rhinitis in Concomitant Asthma.

    Science.gov (United States)

    Sahadevan, A; Cusack, R; Lane, S J

    2015-01-01

    Seasonal allergic rhinitis (AR) occurs predominantly as a result of grass pollen allergy. Grass pollen sublingual immunotherapy (SLIT) has been proven effective in treating AR1. SLIT is currently licensed for use in AR with concomitant stable mild asthma. There is evidence that SLIT improves asthma control when primarily used to treat AR2. The aim was to assess the safety of SLIT in patients with severe seasonal allergic rhinitis who have co-existing stable mild asthma. The secondary aim was to determine whether asthma control improved post SLIT. There was no deterioration in asthma control after 6-36 months of SLIT. 27/30 (90%) patients' asthma control remained stable or indeed improved (p < 0.021). Of this 15 (50%) patients' asthma improved. There was no statistically significant change in their asthma pharmacotherapy after SLIT (p = 0.059). In conclusion, grass pollen SLIT is safe and can potentially treat dual allergic rhinitis- mild asthmatic patients. PMID:26817287

  3. CONCOMITANT DENS EVAGINATUS & DENS INVAGINATUS IN A MAXILLARY LATERAL INCISOR: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Kamal Kiswani

    2013-07-01

    Full Text Available Dens evaginatus also referred to as a talon's cusp, is a developmental anomalycharacterized by formation of a well - delineated additional cusp that extends from thecementoenamel junction to the incisal edge. Dens invaginatus is a developmentalanomaly caused by invagination of the surface of the tooth crown before calcificationhas occurred. Dens evaginatus and dens invaginatus are usually present in isolationand many cases have been reported. But, their concomitance is highly rare and unusualand requires documentation. A case report of a 9 year old child with a combination ofthe talon cusp and dens invagination in the right maxillary lateral incisor is presentedhere. Such a tooth due to its unusual morphology is susceptible to food lodgmentleading to carious invasion. Hence early diagnosis and prophylactic therapy isimportant.

  4. Concomitant chemo-radiotherapy in infiltrating bladder cancer: a new therapeutic approach

    International Nuclear Information System (INIS)

    Until now, radical cystectomy has been considered the most effective treatment for invasive bladder cancer. However, it fails to cure more than 50% of patients and can result in a mediocre quality of life. In an effort to improve cure rates, combined modality regimens have been investigated. Despite the preliminary results of early clinical trials, randomized trials have most often failed to show any benefit from neo-adjuvant or adjuvant chemotherapy or radiotherapy. One of the major progress brought by radiotherapy has been the wide use of conservative treatment in several cancer, and i n the recent years promising results with concomitant radio-chemotherapy have been published. Use of the conservative approach in bladder cancer now appears to be a tangible reality for selected patients, but these combined modalities have not yet been tested in randomized trials. (authors)

  5. Successful Hematopoietic Stem Cell Transplantation Following a Cyclophosphamide-Containing Preparative Regimen with Concomitant Phenobarbital Administration

    Directory of Open Access Journals (Sweden)

    Catherine Weber

    2012-01-01

    Full Text Available Cyclophosphamide is an immunosuppressive agent and an anticancer prodrug which requires bioactivation catalyzed primarily by cytochrome P450 enzymes in order to be transformed into its active alkylating compounds. Concomitant administration of drugs known to inhibit or induce this enzyme system is a clinical concern. Herein, we present the case of a chronically ill 21-year-old patient who received high-dose cyclophosphamide, equine antithymocyte globulin (eATG, and total body irradiation (TBI followed by an allogeneic hematopoietic stem cell transplant (HSCT for severe aplastic anemia. Throughout her hospitalization, she continued to receive quadruple anticonvulsant therapy including phenobarbital for her long-standing seizure history. The preparative regimen was tolerated well aside from a hypersensitivity reaction to eATG, and minimal cyclophosphamide-related toxicities. Safe and effective administration of high-dose cyclophosphamide was possible with multidisciplinary care consisting of physician, nursing, pharmacy, neurology consultation, as well as social work and case management.

  6. Concomitance and interactions of pathogens in the Iberian wolf (Canis lupus).

    Science.gov (United States)

    Oleaga, A; Vicente, J; Ferroglio, E; Pegoraro de Macedo, M R; Casais, R; del Cerro, A; Espí, A; García, E J; Gortázar, C

    2015-08-01

    With the aim of improving our understanding of their epidemiological features, exposure to or presence of Canine Parvovirus (CPV), Canine Distemper Virus (CDV), Leishmania infantum and Sarcoptes scabiei were studied in 88 wild wolves from Asturias (Northern Spain) by means of long-term (2004-2010) serological and molecular data. Individual and population factors and the possible interactions between them were also statistically analyzed for better understanding the contact/presence of studied pathogens. The overall seroprevalence values were 19%, 61%, 20% and 0% for CDV, CPV, S. scabiei and Leishmania, respectively, while a 46% of studied wolves showed Leishmania genetic material presence. Sarcoptic mange, CDV and CPV showed higher seroprevalence values in the areas with higher wolf densities, and a positive association between CDV and S. scabiei antibody responses was detected. Reported data highlight the need of considering concomitant pathogens and their possible interactions for a better understanding of diseases and their management in wildlife. PMID:26267084

  7. Tissue Penetration of Capecitabine and Its Tumor-Selective Delivery of 5-FU in Advanced Breast Cancer Patients%卡培他滨乳腺组织穿透及向氟脲嘧啶转化的药动学研究

    Institute of Scientific and Technical Information of China (English)

    叶敏; 朱珠; 付强; 孙强; 茅枫

    2006-01-01

    Aim To measure the penetration of capecitabine from the plasma into tissue and to investigate the pharmacokinetics of its metabolizing into fluorouracil (5-FU) in patients with advanced breast cancer. Methods Twenty-seven patients with breast cancer received repeated doses of 1 255 mg·m-2 of capecitabine twice daily for 7 d. Blood, tumor, and adjacent healthy tissue samples were collected. The concentrations of capecitabine and its metabolite 5-FU were determined by HPLC. The concentration-time profiles of capecitabine and 5-FU were fitted by pharmacokinetic model. The tissue distribution factors for capecitabine and 5-FU, and the AUC ratios of 5-FU to capecitabine in plasma, tumor or adjacent healthy tissue, were calculated with pharmacokinetic parameters, respectively. Results The Ka of capecitabine was 1.17 h-1 in plasma, 0.46 h-1 in tumor tissue, and 0.61 h-1 in healthy tissue. The AUCs of capecitabine were 2.557 1 μg·mL-1·h, 1.629 2 μg·g-1·h and 2.085 0 μg·g-1·h, and T1/2 was 0.782 3 h, 1.528 1 h and 1.289 6 h in plasma, tumor, and healthy tissue, respectively. The AUCs of 5-FU were 0.418 7 μg·mL-1 h, 1.671 7 μg·g-1·h and 1.020 8 μg·g-1·h; the T1/2 was 0.631 3 h ,1.204 1 h and 1.031 2 h in plasma, tumor, and healthy tissue, respectively. The tissue distribution factors of capecitabine were 0.637 1 in tumor (AUCcap-Tumor/AUCcap-plasma) and 0.851 4 in healthy tissue (AUCcap-HT/AUCcap-plasma). The tissue distribution factors of 5-FU were 3.992 6 in tumor (AUC5-FU-tumor/AUC5-FU-plasma) and 2.438 0 in healthy tissue (AUC5-FU-HT/AUC5-FU-plasma). The AUC ratios of 5-FU to capecitabine were 0.1637, 1.0261, and 0.489 5 in plasma, tumor, and healthy tissue, respectively. Conclusion The simulation curves for the disposition of capecitabine and its metabolite 5-FU in plasma and tissue basically describe the activation process of capecitabine metabolizing to 5-FU and 5-FU elimination. There are similar distributions for capecitabine in plasma, tumor, and

  8. Prevalence and concomitants of arthritis in the elderly in Rio Grande do Sul, Brazil.

    Directory of Open Access Journals (Sweden)

    Sergio L Blay

    Full Text Available OBJECTIVES: Information on the prevalence and concomitants of arthritis in developing countries is sparse. It is unclear whether they are comparable to findings in developed countries. To ascertain the prevalence, demographic characteristics, and health-related concomitants of arthritis in older persons in the southern state of Rio Grande do Sul, Brazil, a middle income country. METHODS: The state of Rio Grande do Sul, Brazil, was subdivided into nine regions. Stratified random sampling was used to identify 880 community residents age ≥60 years in each region. One region with suspect data was excluded. Of 7040 community residents contacted in eight regions, 6963 participated (1.1% refusal rate. In 1995, trained, monitored interviewers, using structured questionnaires, conducted in-home interviews gathering information on demographic characteristics (age, sex, race/ethnicity, education, income, living arrangements, employment status, health behaviors (physical activity, tobacco use, social activity, functional limitations, depression, and 15 self-reported health conditions, including arthritis. Data were analyzed using descriptive statistics and logistic regression. RESULTS: Arthritis, reported by 43% of the sample, was more prevalent in women, among the less educated, those with lower income, and higher age. Severity, but not prevalence, differed by race/ethnicity. Controlled analyses indicated significant association with female gender, lower education, and less social activity. Arthritis was associated with reduced odds of stroke, but increased odds of hypertension, varicosities, bronchitis, renal problems, headache, gastrointestinal disorders, and depression. Arthritis was not significantly associated with age or functional limitations, and associations did not differ by gender. CONCLUSIONS: The prevalence, demographic and health characteristics associated with self-reported arthritis in this southern state in Brazil are similar to findings

  9. Comparison of vinorelbine with cisplatin in concomitant chemoradiotherapy in head and neck carcinoma

    Directory of Open Access Journals (Sweden)

    Devleena

    2010-03-01

    Full Text Available Aim: Head and neck cancer is one of the most commonly occurring malignancies in the world. In India, the most commonly occurring head and neck cancers are those of the oral cavity and the pharynx. The majority of these cancers present with stage III/IV disease. Surgery and radiation therapy are the main treatment modalities. Concomitant chemoradiation is being investigated with the goal of improved local control that translates into improved survival. In this background, we have started this prospective randomized trial to ascertain the dose, schedule and sequence of therapy and to note whether Vinorelbine as radiosensitizer is equally effective as Cisplatin, comparing compliance, local control and toxicity. Patients and Methods: Forty patients of advanced head and neck cancer were randomized into two arms. Arm A received weekly injection Cisplatin 40mg/m 2 along with radiation. Arm B received weekly injection of Vinorelbine 6mg/m 2 along with radiation. Radiotherapy was delivered at a dose of 6,600-7,000 Gy in conventional fractionation in a telecobalt machine. Results: The complete response (CR rate was higher in arm B (90% than in arm A (70%. Major toxicities included neutropenia, anemia, mucositis and nausea. Conclusion: Concomitant chemoradiation with Vinorelbine produced more CR than chemoradiation with Cisplatin in advanced head and neck cancer. Toxicities were more in the Cisplatin arm, but they were manageable. Although a majority of the study was performed using Cisplatin as the radiosensitizer, Vinorelbine can be recommended as radiosensitizer in advanced head and neck malignancy.

  10. Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma

    Directory of Open Access Journals (Sweden)

    Matlach Juliane

    2013-01-01

    Full Text Available Abstract Background Cataract and glaucoma are both common comorbidities among older patients. Combining glaucoma surgery with minimal invasive phacoemulsification (phaco is a considerable option to treat both conditions at the same time, although the combination with filtration surgery can produce a strong inflammatory response. Combined non-penetrating procedures like canaloplasty have shown to reduce intraocular pressure (IOP comparable to trabeculectomy without the risk of serious bleb-related complications. The purpose of this retrospective study was to compare the outcomes of phacotrabeculectomy and phacocanaloplasty. Methods Thirty-nine eyes with concomitant cataract and glaucoma who underwent phacotrabeculectomy (n = 20; 51.3% or phacocanaloplasty (n = 19; 48.7% were included into this trial on reduction of IOP, use of medication, success rate, incidence of complications and postsurgical interventions. Complete success was defined as IOP reduction by 30% or more and to 21 mmHg or less (definition 1a or IOP to less than 18 mmHg (definition 2a without glaucoma medication. Results Over a 12-month follow-up, baseline IOP significantly decreased from 30.0 ± 5.3 mmHg with a mean of 2.5 ± 1.2 glaucoma medications to 11.7 ± 3.5 mmHg with a mean of 0.2 ± 0.4 medications in eyes with phacotrabeculectomy (P  Conclusions Phacocanaloplasty offers a new alternative to phacotrabeculectomy for treatment of concomitant glaucoma and cataract, although phacotrabeculectomy yielded in better results in terms of IOP maintained without glaucoma medications.

  11. Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer.

    Science.gov (United States)

    Hatanaka, Takeshi; Itoi, Takao; Ijima, Masashi; Matsui, Ayako; Kurihara, Eishin; Okuno, Nozomi; Kobatake, Tsutomu; Kakizaki, Satoru; Yamada, Masanobu

    2016-01-01

    Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer. PMID:27250045

  12. Surface contamination initiated laser damage

    International Nuclear Information System (INIS)

    We are engaged in a comprehensive effort to understand and model the initiation and growth of laser damage initiated by surface contaminants. This includes, for example, the initial absorption by the contaminant, heating and plasma generation, pressure and thermal loading of the transparent substrate, and subsequent shockwave propagation, ''splashing'' of molten material and possible spallation, optical propagation and scattering, and treatment of material fracture. The integration use of large radiation hydrodynamics codes, optical propagation codes and material strength codes enables a comprehensive view of the damage process The following picture of surface contaminant initiated laser damage is emerging from our simulations. On the entrance optical surface, small particles can ablate nearly completely. In this case, only relatively weak shockwaves are launched into the substrate, but some particulate material may be left on the surface to act as a diffraction mask and cause further absorption. Diffraction by wavelength scale scattering centers can lead to significant intensity modulation. Larger particles will not be completely vaporized. The shockwave generated in this case 1642is larger and can lead to spallation of contaminant material which then may be deposited in the substrate. A gaseous atmosphere can lead to radiation trapping with concomitant increases in temperature and pressure near the surface. In addition, supersonic ionization waves in air may be generated which greatly extend the plasma plume spatially and temporally. Contaminants on the exit optical surface behave differently. They tend to heat and pop off completely in which case significant damage may not occur. Since plasma formed at the interface of the optic and absorbing particle is confined, much stronger pressures are generated in this case. Imaging of contaminants resulting in ''writing'' a diffraction pattern on the exit surface due to contamination on the entrance surface has been

  13. 吉西他滨联合卡培他滨治疗难治性乳腺癌的临床观察%Clinical observation of gemcitabine plus capecitabine in treatment of 50 metastatic breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    周小宁; 周成英; 严必中; 陈艳; 陈书巧

    2012-01-01

    Objective To evaluate the results of combination chemotherapy with gemcitabine plus capecitabine in the treatment of metastatic breast cancer. Methods 50 patients with metastatic breast cancer accepted gemcitabine plus capecitabine chemotherapy. Response and side effect were evaluated by WHO standard methods. Results Among 50 cases who could be evaluated,4 patients achieved complete response ( CR) ,22 patients achieved partial response(PR) ,18 patients had no change(NC) , 6 patients had progressive disease(PD) ,median time to progression was 8. 3 (95% CI;6. 55-10. 89) months and median overall survival time was 18. 0(95%CI:14. 34-21. 98) months. The major adverse events were bone marrow suppression and skin rash. Conclusions Gemcitabine plus capecitabine is effective and well tolerated for metastatic breast cancer, it gives us a new choice.%目的 观察吉西他滨联合卡培他滨(GX方案)治疗术后复发的乳腺癌患者的疗效和不良反应.方法 50例患者分别接受GX方案化疗3~6个周期,按世界卫生组织(WHO)标准评价疗效及不良反应.结果 50例患者均可评价,其中完全缓解(CR)4例(8.0%),部分缓解(PR)22例(44.0%),稳定(SD)18例(36.0%),进展(PD)6例(12.0%).中位肿瘤进展时间(mTTP)为8.3个月(95% CI:6.55 ~ 10.89),中位总生存时间(mOS)为18.0个月(95% CI:14.34 ~ 21.98).主要不良反应为骨髓抑制和皮疹.结论 GX方案治疗晚期乳腺癌安全有效,不良反应较轻,值得临床推广应用.

  14. 吉西他滨联合卡培他滨治疗转移性三阴性乳腺癌的临床观察%Clinical Outcomes of Gemcitabine Combined Capecitabine with Metastatic Triple-negative Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    李景; 高俊峰

    2013-01-01

    Objective:To observe the ef ect and side reaction of Gemcitabine combined capecitabine inmetastatic triple-negative breast cancer. Method:28 patients with metastatic triple-negative breast cancer were enrol ed. Capecitabine was oral dose with 2000mg/m2 per day though day 1 to day 14 and Gemcitabine injected with 1000mg/m2 at day 1 and day 8. Every 2 weeks repeated. Results:The outcomes in 28 patients included completed response (n=2,7.14%),partial response (n=10,35.7%) , stable disease (n=10,35.7%),progressive disease (n=6,21.4%) Total ef ective rate was 42.9%. Conclusion: Gemcitabine combined capecitabine was ef ective plan with with metastatic triple-negative breast cancer after the patients were failed with anthracycline and/or taxanes.%目的观察吉西他滨联合卡培他滨治疗蒽环及紫杉类药物耐药的转移性三阴性乳腺癌的疗效及不良反应。方法28例转移性三阴性乳腺癌患者,卡培他滨2000mg/m2·d,第1~14d,早晚饭后30min,2次/d口服;吉西他滨1000mg/m2,第1、8d,3周天为1周期。结果28例患者中,CR2例(7.14%),PR 10例(35.7%),SD 10例(35.7%),PD6例(21.4%),总有效率(CR+PR)为42.9%。结论卡培他滨联合吉西他滨治疗蒽环类和(或)紫杉类耐药转移性三阴性乳腺癌患者疗效较好,不良反应可以耐受.可以作为蒽环类和(或)紫杉类耐药的晚期三阴性乳腺癌患者的一个有效解救方案。

  15. Clinical observation on treatment of breast cancer liver metastases with docetaxel combined with capecitabine%多西紫杉醇联合卡培他滨治疗乳腺癌肝转移的临床观察

    Institute of Scientific and Technical Information of China (English)

    陈云兰; 赵金奇

    2012-01-01

    目的:观察多西紫杉醇联合卡培他滨(TX)序贯卡培他滨单药维持治疗乳腺癌肝转移( breast cancer liver metastases,BCLM)的疗效和安全性.方法:回顾性分析TX方案治疗蒽环/和紫杉类药治疗的乳腺癌肝转移患者39例.全组共化疗230周期,中位周期数6周期(4-8周期).有效者TX方案化疗6-8周期后序贯卡培他滨单药维持直至不能耐受或病情进展.结果:全组39例患者,4周期化疗后CR0例,PR 20例(51.3%),SD14例(35.9%),PD 5例(12.8%),有效率51.3%,临床获益率87.2%.TTP 2.8-36.5月,中位TTP5月.结论:应用TX方案序贯卡培他滨维持治疗蒽环/和紫杉类治疗后乳腺癌肝转移疗效确切,毒副反应能耐受,值得临床推广.%Objective:To study the efficacy and safety of docetaxel combined with capecitabine (TX) sequential capecitabine single - agent maintenance treatment for breast cancer liver metastases ( BCLM) . Methods; The data of 39 breast cancer patients with liver metastasis were analyzed retrospectively treated by TX anthraquinone ring/and taxane combinations. All patients were treated by chemotherapy for 230 cycles, median cycle number was 6(4 to 8 cycles ). Results: Of 39 cases, CR 0 case, PR 20 cases (51.28%),SD 14 cases (35.9%), PD 5 cases (12.82%), effictive rate was 51. 28%, clinical benefit rate (87. 18%). Conclusion: Application of TX square sequential capecitabine maintenance treatment anthracene ring/and taxane combinations for liver breast cancer metastasis and side - effect are tolerated.

  16. Bilateral posterior RION after concomitant radiochemotherapy with temozolomide in a patient with glioblastoma multiforme: a case report

    International Nuclear Information System (INIS)

    Radiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide. The case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg) the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed. In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy

  17. Efficacy and Safety of Moderate-dose Capecitabine in Treatment of Metastatic Breast Cancer%中等剂量卡培他滨单药治疗转移性乳腺癌的疗效及安全性

    Institute of Scientific and Technical Information of China (English)

    严颖; 任军; 林晓琳; 宛凤玲; 邸立军

    2012-01-01

    Objective To determine activity and safety of capecitabine at a moderate dose of 2000 mg/(m2 · d) for metastatic breast cancer. Methods In this retrospective trial, 43 metastatic breast cancer patients received first-line capecitabine 2 000 mg/m2 on days 1 —14 every 3 weeks. Results 43 metastatic breast cancer patients received mean 8 cycles of capecitabine therapy. Median PFS was 7. 1 months (95% CI:5.8~8.4). There were no difference among the first line,the second line and third line treatment 7. 1 months,6. 1 months, and 8. 1 months respectively (P = 0. 390). Patients pretreated with both anthracy-cline and taxane therapy had a significantly shorter PFS(6. lmonths vs. 7. 1 months, P = 0. 038) , but pa-tients>65 years achieved a significantly longer PFS(8. 1 months vs. 6. 1 months,P= 0. 045). Ninteen cases (44. 2%) had hand-foot syndrome, a main toxicity. Conclusion Capecitabine at a moderate dose of 2 000 mg/(m2 · d)is active and well-tolerated for metastatic breast cancer.%目的 观察中等剂量[2000mg/(m2·d)]卡培他滨治疗转移性乳腺癌的疗效和不良反应.方法 卡培他滨单药治疗43例转移性乳腺癌,2000mg/(m2·d),d1~14,每3周为1周期.结果 43例患者平均行8周期卡培他滨治疗,客观缓解率(CR+ PR)为18.6%,临床获益率(CR+ PR+ SD)为86.0%.整体的中位无进展生存期(PFS)为7.1月(95%CI:5.8~8.4),在一线治疗、二线治疗和三线及以上治疗亚组中差异无统计学意义,分别为7.1月、6.1月和8.1月(P=0.390).在蒽环类药物与紫杉类药物治疗均失败的患者中,PFS明显缩短(6.1月vs.7.1月,P=0.038).大于65岁的患者PFS显著延长(8.1月vs.6.1月,P=0.045).主要不良反应为手足综合征19例(44.2%).结论 中等剂量[2000 mg/(m2·d)]卡培他滨单药治疗转移性乳腺癌安全、有效.

  18. 吉西他滨联合卡培他滨治疗乳腺癌56例疗效分析%Gemcitabine combined with capecitabine in the treatment of breast cancer in 56 cases

    Institute of Scientific and Technical Information of China (English)

    肖斌

    2013-01-01

    Objective To observe the clinical efficacy of gemcitabine combined with card capecitabine in the treatment of breast cancer. Methods Gemcitabine Combined with capecitabine chemotherapy on March, 2010 ~ 2012 year in October to 56 cases of breast cancer patients in our hospital with 1000mg/m2, intravenous infusion of 30min, on the first day and the eighth day medication; capecitabine 2500mg/m2, sooner or later the two oral, even for 14 days, after the break 7 days, 21 days for a treatment cycle, 4 cycles, to observe the clinical efficacy and adverse reactions. Results In 56 patients, 3 cases of complete remission, partial remission in 24 cases, 29 cases ineffective, the total effective rate was 48.2%; the course of treatment in patients with appeared gastrointestinal reaction and bone marrow suppression, hand foot syndrome and other adverse reactions, but were in the tolerable range. Conclusion Gemcitabine Combined with capecitabine in the treatment of breast cancer with good clinical efficacy, and adverse reactions can be tolerated, it is worthy of clinical application.%目的观察吉西他滨联合卡培他滨治疗乳腺癌的临床疗效。方法对2010年3月至2012年10月来本院就诊的56例乳腺癌患者给予吉西他滨联合卡培他滨的方案治疗,吉西他滨1000mg/m2,静脉滴注30min,于第一天和第八天给药;卡培他滨2500mg/m2,早晚两次口服,连用14天,后休息7天,21天为一个治疗周期,4个周期后,观察临床疗效和不良反应。结果56例患者中完全缓解3例,部分缓解24例,无效29例,治疗总有效率为48.2%;治疗过程中患者可出现胃肠道反应、骨髓抑制及手足综合征等不良反应,但均在患者可耐受范围。结论吉西他滨联合卡培他滨治疗乳腺癌临床疗效较好,且不良反应可以耐受,值得临床推广应用。

  19. Docetaxel plus Capecitabine Combination Therapy for Patients with Anthracycline-resistant Metastatic Breast Cancer%多西紫杉醇联合卡培他滨治疗蒽环类耐药的晚期乳腺癌

    Institute of Scientific and Technical Information of China (English)

    柴文英; 马芸; 李萍; 钱锦贤; 蒋爱梅

    2011-01-01

    目的:观察多西紫杉醇联合卡培他滨(DC)治疗蒽环类耐药晚期乳腺癌的疗效和安全性.方法:31例经病理证实的蒽环类耐药的转移性乳腺癌患者,采用多西紫杉醇联合卡培他滨化疗.剂量为多西紫杉醇75mg/m2,静滴,d1;希罗达2 500mg/m2,口服,d1~d14,21天为1个周期,化疗至疾病进展或不良反应无法耐受.根据WHO制定的实体瘤客观疗效评价标准和抗癌药物毒性分级标准评价疗效和不良反应.结果:31例患者共完成118个周期化疗,每例患者化疗2个~8个周期,中位周期数4个.31例患者中,完全缓解1例(3.2%),部分缓解16例(51.6%),稳定10例(32.3%),进展4例(12.9%),总有效率为54.8%.中位肿瘤进展时间6.3个月,中位生存期13个月,1年生存率为58.8 %.主要不良反应为骨髓抑制、胃肠道反应和手足综合征,患者均可耐受.结论:多西紫杉醇联合卡培他滨治疗蒽环类耐药晚期乳腺癌的疗效较好,不良反应可以耐受,是治疗蒽环类耐药晚期乳腺癌的有效方案.%Objective: To evaluate the efficacy and toxicity of docetaxel plus capecitabine in the treatment of anthracycline-resistant metastatic breast cancer. Methods: Thirty-one patients with anthracycline-resistant metastatic breast cancer were treated with chemotherapy combined with docetaxel and capecitabine. Docetaxel ( 75mg/m2 ) was given intravenously on d1 and capecitabine ( 2 500mg/m2 )was taken orally on d1 to d14, every 21 days as one cycle. Results: A total of 118 cycles of the regimen were administered in the 31 cases with a median of 4 cycles( range 2 ~ 8 cycles for each patient ). The overall response rate was 54.8%. Among the 31 patients, one got complete response( CR ), 16 partial response( PR ), 10 stable disease( SD ) and4 progressive disease( PD ). The median time of progression ( TTP ) was 6.3 months. The median survival time was 13 months. The one-year survival rate was 58.8%.The major toxicity and adverse effects

  20. Clinical Observation of Simple Capecitabine in Chemotherapy of Recrudescent and Metastatic Stomach Carcinoma%卡培他滨单药治疗复发转移性胃癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    吴月兵; 臧爱华

    2010-01-01

    @@ 0 引言 目前对于复发转移性胃癌尚无成熟的化疗方案指导治疗,也没有成熟的标志物或临床指标指导个体化化疗方案的进行.我们于2006年4月-2009年4月应用卡培他滨(Capecitabine,商品名:Xeloda,希罗达)治疗复发转移性胃癌40例,观察患者血清中癌胚抗原(carcinoembryonic antigen,CEA)、CA199(cancer antigen 199)水平的变化及不良反应,以期为临床早期治疗提供参考,现报告如下.

  1. Concurrent weekly docetaxel and concomitant boost radiation therapy in the treatment of locally advanced squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    Purpose: In a Phase I/II trial, we investigated concurrent weekly docetaxel and concomitant boost radiation in patients with locally advanced squamous cell cancer of the head and neck (SCCHN) after induction chemotherapy. Patients and Methods: Patients presented with American Joint Committee on Cancer Stage III/IV and were treated initially with induction chemotherapy using cisplatinum/5-fluorouracil (PF), carboplatinum-5-FU, or docetaxel-PF. Patients then received docetaxel four times weekly with concomitant boost (CB) radiation (1.8 Gy once-daily X20, 1.8/1.5 Gy twice a day). Fifteen patients each received 20 mg/M2 and 25 mg/M2. Results: Thirty-one patients were enrolled and 30 were evaluable for response and toxicity. Median follow-up was 42 months (range, 27-63 months). Primary sites were: oropharynx 19, oral cavity 2, larynx/hypopharynx 5, and unknown primary 4. Eighty-seven percent of patients had N2/N3 disease; 60% had T3/T4 disease. Twenty percent of patients had a complete response (CR) to induction chemotherapy. After chemoradiotherapy, 21 of 30 patients had a CR, 2 had progressive disease, and 7 had partial response (PR). Nineteen of 26 patients presenting with neck disease had neck dissections, and 7 of 19 were positive. Ninety-three percent of all patients were rendered disease-free after all planned therapy. Treatment failed in 8 patients, and 7 have died of disease. An additional patient died with no evidence of disease. Twenty-one patients (70%) are currently alive with no evidence of disease. No acute dose-limiting toxicity was observed at either dose level. Conclusions: This intensive treatment regimen of concurrent docetaxel/concomitant boost radiation and surgery after induction chemotherapy in poor prognosis patients yields good local regional control and survival. Docetaxel/CB chemoradiotherapy represents an aggressive alternative regimen to platinum-based chemoradiotherapy or surgery in patients who have a poor response to induction

  2. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity

    International Nuclear Information System (INIS)

    Purpose: To report the acute and late toxicities of patients with high-risk localized prostate cancer treated using a concomitant hypofractionated, intensity-modulated radiotherapy boost combined with long-term androgen deprivation therapy. Methods and Materials: A prospective Phase I-II study of patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level ≥20 ng/mL, or Gleason score 8–10. A dose of 45 Gy (1.8 Gy/fraction) was delivered to the pelvic lymph nodes with a concomitant 22.5 Gy prostate intensity-modulated radiotherapy boost, to a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions within 5 weeks. Image guidance was performed using three gold seed fiducials. The National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, and Radiation Therapy Oncology Group late morbidity scores were used to assess the acute and late toxicities, respectively. Biochemical failure was determined using the Phoenix definition. Results: A total of 97 patients were treated and followed up for a median of 39 months, with 88% having a minimum of 24 months of follow-up. The maximal toxicity scores were recorded. The grade of acute gastrointestinal toxicity was Grade 0 in 4%, 1 in 59%, and 2 in 37%. The grade of acute urinary toxicity was Grade 0 in 8%, 1 in 50%, 2 in 39%, and 3 in 4%. The grade of late gastrointestinal toxicity was Grade 0 in 54%, 1 in 40%, and 2 in 7%. No Grade 3 or greater late gastrointestinal toxicities developed. The grade of late urinary toxicity was Grade 0 in 82%, 1 in 9%, 2 in 5%, 3 in 3%, and 4 in 1% (1 patient). All severe toxicities (Grade 3 or greater) had resolved at the last follow-up visit. The 4-year biochemical disease-free survival rate was 90.5%. Conclusions: A hypofractionated intensity-modulated radiotherapy boost delivering 67.5 Gy in 25 fractions within 5 weeks combined with pelvic nodal radiotherapy and long-term androgen deprivation therapy was well tolerated, with low rates

  3. Phase II Study of Concomitant Thalidomide During Radiotherapy for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ch' ang, Hui-Ju, E-mail: hjmc@nhri.org.tw [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan (China); Hsu, Chiun [Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Chen, Chien-Hung [Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (China); Chang, Ya-Hui; Chang, Jeffrey S. [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Chen, Li-Tzong [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (China)

    2012-02-01

    Purpose: Thalidomide has been demonstrated to possess antitumor activity in patients with advanced hepatocellular carcinoma (HCC). The objective of the present study was to determine whether the combined treatment of thalidomide with radiotherapy (RT) is associated with acceptable toxicity and an improved clinical outcome in HCC patients. Methods and Materials: A total of 24 patients were enrolled to receive RT combined with thalidomide. A total dose of 50 Gy was delivered in 2-Gy fractions within 5 weeks. Thalidomide was administered 100 mg twice daily starting 3 days before RT until the development of unacceptable toxicity or disease progression. Blood samples were collected before, during, and after treatment to measure the levels of angiogenic factors and cytokines. The results of patients receiving the combined therapy were compared with those from 18 HCC patients receiving RT only. Results: No significant difference in the clinical parameters was noted between the two groups, except for the baseline interleukin-6 level, which was greater in the concomitant group (p = .05). The most common toxicities related to thalidomide use were skin rash (54.2%), somnolence (37.5%), and constipation (33.3%). No significant differences were seen in the response rate (55.6% vs. 58.3%, p = .48), median progression-free survival (182 {+-} 48.9 vs. 148 {+-} 6.2 days, p = .15), or median overall survival (258 {+-} 45.6 vs. 241 {+-} 38.6, p = .16) between those who received concomitant therapy and those who received RT alone. Thalidomide suppressed the serum basic fibroblast growth factor level significantly during RT (p = .03) and, to a lesser extent, the interleukin-6 and tumor necrosis factor-{alpha} levels. After adjusting for other potential prognostic factors in the multivariate analysis, only the baseline interleukin-6 level and stem cell-derived factor-1 during RT independently predicted the progression-free survival. A decreased serum stem cell-derived factor-1 level 1

  4. Tolerability of diclofenac sodium 1% gel with concomitant medications known to interact with diclofenac

    Directory of Open Access Journals (Sweden)

    Peniston JH

    2013-04-01

    Full Text Available John H Peniston,1 Morris S Gold,2 Matthew S Wieman,3 Lawrence K Alwine4 1Feasterville Family Health Care Center, Feasterville, PA, 2Novartis Consumer Health, Inc, Parsippany, NJ, 3Endo Pharmaceuticals Inc, Malvern, PA, 4Downingtown Family Medicine, Downingtown, PA, USA Background: Topical diclofenac sodium 1% gel (DSG has demonstrated efficacy and tolerability in patients with osteoarthritis (OA of the knees or hands, including elderly patients and those with an increased risk of gastrointestinal, cardiovascular, and renal adverse events (AEs. Medications known to interact with diclofenac were disallowed in a clinical trial of DSG for knee OA; however, patients were not to be discontinued for intake of disallowed treatment, unless there was a safety issue. This post hoc analysis examined the frequency and type of AEs in patients who received DSG concomitantly with drugs known to have potential interactions with diclofenac. Materials and methods: This was a post hoc analysis of a randomized controlled trial of DSG for knee OA pain. Patients (n = 254 aged ≥ 35 years with OA in one or both knees, but with clinical OA symptoms in only one knee, administered DSG topically to the target knee four times daily (total dose, 16 g/d for 12 weeks. Drugs with the potential for major or moderate drug–drug interactions (DDIs were identified via Drugs.com. AE rates were compared in patients with versus those without ≥1 potential DDI. Results: At least one AE was experienced by 62.6% (107/171 of patients with ≥1 DDI and by 55.4% (46/83 of patients with no DDIs. Gastrointestinal AEs (upper and lower were reported in 5.3% (9/171 and 7.2% (6/83, cardiovascular AEs in 4.7% (8/171 and 1.2% (1/83, renal AEs in 1.2% (2/171 and 0%, and hepatic AEs in 0% and 1.2% (1/83 of patients with ≥1 DDI compared with patients with no DDIs, respectively. Conclusion: Concurrent use of DSG with medications that had potential for major to moderate DDIs had little impact on

  5. A feasibility study of concomitant boost radiotheraphy for patients with cancer of the supraglottic larynx

    International Nuclear Information System (INIS)

    Between February 1988 and December 1989, 65 patients with supraglottic cancer completed a course of concomitant boost radiotherapy. Cases with N3 disease, a Karnovsky performance score less than 70, age above 70 years, or a second primary cancer were not eligible for the study. Distribution of the patients was: Stage T1-T2 30%, T3-T4 70%, N0 68%, N+32%. The total dose ranged from 60 Gy to 76 Gy (median 66 Gy); overall treatment time ranged from 36 to 56 days with a median of 42 days. The daily dose during the first 4 weeks was 1.8 Gy, and during the last 2 weeks it was 1.6 Gy b.i.d. with a 4- or (after September 1988) 6-h interval. The clinical impression was that the early mucosal reactions were acceptable but more severe than after conventional treatment, with confluent membranous mucosal reaction being observed in 54% of the patients. Also, this reaction was significantly more frequent in patients treated with a 4-h interval (68%) than with a 6-h interval (41%) between the daily fractions. To relieve severe dysphagia, narcotics were required in 22% of the patients. The follow-up time ranged from 22 to 50 months, median 34 months. Treatment-requiring late complications were observed in 8 patients, and the 3-year actuarial risk was 17% with 95% confidence limits (6%, 27%). Two of these patients had severe complications: One of them required a temporary tracheostomy due to arytenoid edema and the other developed a laryngo-cutaneous fistula which healed after pharmacological treatment. Actuarial 3-year local-regional control was 59% (46%, 71%) and 3-year actuarial crude survival 55% (42%, 67%). There was no significant difference in the incidence of late complications or tumor control between the two groups of patients treated with a 4- or 6-h interval between the daily fractions. This study shows that the concomitant boost regimen tired here is feasible, but also stresses that the interval between dose fractions should be 6 h or more. (orig.)

  6. Concomitant radiochemotherapy of cervical cancer. Is it justified to reduce the dosage of cisplatin?

    International Nuclear Information System (INIS)

    Purpose: to review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses. Patients and methods: at the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m2, 30 mg/m2, or 20 mg/m2 was administered once a week. Results: In 17 cases, the cisplatin dose was 30 mg/m2; during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m2 cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m2; in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m2, and grade G3-4 in 16% of the 40-mg/m2 cisplatin group. For cisplatin 30 mg/m2, 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m2 regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m2 and 40 mg/m2, respectively. Conclusion: on the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m2 was administered instead of 40 mg/m2. If cisplatin 20 mg/m2 was given

  7. A feasibility study of concomitant boost radiotheraphy for patients with cancer of the supraglottic larynx

    Energy Technology Data Exchange (ETDEWEB)

    Bujko, K. (Dept. of Radiotherapy 2, Center of Oncology-Inst., Warsaw (Poland)); Skoczylas, J.Z. (Danish Cancer Society, Dept. of Experimental Clinical Oncology, Aarhus (Denmark)); Bentzen, S.M. (Danish Cancer Society, Dept. of Experimental Clinical Oncology, Aarhus (Denmark)); Hliniak, A. (Dept. of Radiotherapy 2, Center of Oncology-Inst., Warsaw (Poland)); Wasilewski, M. (Dept. of Radiotherapy 2, Center of Oncology-Inst., Warsaw (Poland)); Szutkowski, Z.J. (Dept. of Radiotherapy 2, Center of Oncology-Inst., Warsaw (Poland)); Osmolski, A. (ENT, Dept. of the Postgraduate Teaching Medical Center, Warsaw (Poland))

    1993-01-01

    Between February 1988 and December 1989, 65 patients with supraglottic cancer completed a course of concomitant boost radiotherapy. Cases with N3 disease, a Karnovsky performance score less than 70, age above 70 years, or a second primary cancer were not eligible for the study. Distribution of the patients was: Stage T1-T2 30%, T3-T4 70%, N0 68%, N+32%. The total dose ranged from 60 Gy to 76 Gy (median 66 Gy); overall treatment time ranged from 36 to 56 days with a median of 42 days. The daily dose during the first 4 weeks was 1.8 Gy, and during the last 2 weeks it was 1.6 Gy b.i.d. with a 4- or (after September 1988) 6-h interval. The clinical impression was that the early mucosal reactions were acceptable but more severe than after conventional treatment, with confluent membranous mucosal reaction being observed in 54% of the patients. Also, this reaction was significantly more frequent in patients treated with a 4-h interval (68%) than with a 6-h interval (41%) between the daily fractions. To relieve severe dysphagia, narcotics were required in 22% of the patients. The follow-up time ranged from 22 to 50 months, median 34 months. Treatment-requiring late complications were observed in 8 patients, and the 3-year actuarial risk was 17% with 95% confidence limits (6%, 27%). Two of these patients had severe complications: One of them required a temporary tracheostomy due to arytenoid edema and the other developed a laryngo-cutaneous fistula which healed after pharmacological treatment. Actuarial 3-year local-regional control was 59% (46%, 71%) and 3-year actuarial crude survival 55% (42%, 67%). There was no significant difference in the incidence of late complications or tumor control between the two groups of patients treated with a 4- or 6-h interval between the daily fractions. This study shows that the concomitant boost regimen tired here is feasible, but also stresses that the interval between dose fractions should be 6 h or more. (orig.).

  8. The Impact of Concomitant Medication Use on Patient Eligibility for Phase I Cancer Clinical Trials

    Directory of Open Access Journals (Sweden)

    Mitesh J. Borad, Kelly K. Curtis, Hani M. Babiker, Martin Benjamin, Raoul Tibes, Ramesh K. Ramanathan, Karen Wright, Amylou C. Dueck, Gayle Jameson, Daniel D. Von Hoff

    2012-01-01

    Full Text Available Concomitant medication (CM use may result in Phase I cancer clinical trial ineligibility due to concern for potential CM-investigational drug interactions or alteration of investigational drug absorption. Few studies have examined the impact of CM use on trial eligibility. Methods: We reviewed records of 274 patients on Phase I trials at a single academic institution. Demographics, CM identities and classes, CM discontinuation, reasons, and incidence of CM substitution were recorded. CM-investigational drug cytochrome P450 (CYP enzyme interactions were documented. Statistical analysis was performed using descriptive statistics. Results: 273 of 274 patients (99.6%, 95% confidence interval [CI] 98.9-100% took CM, with a median of 8 CM per patient (range 0 - 42. CM discontinuation occurred in 67 cases (25%, 95% CI 19-30%. The most common CM classes discontinued were herbal (17 cases, 25%, 95% CI 16-37% and proton pump inhibitors (15 cases, 22%, 95% CI 12-32%. CM discontinuation reasons were: protocol prohibition (32 cases, 48%, 95% CI 36-60%; potential CM-investigational drug interaction (25 cases, 37%, 95% CI 26-49%; other (10 cases, 15%, 95% CI 6-23%. A potential CM-investigational drug CYP interaction was noted in 122 cases (45%, 95% CI 39-50%. CM potentially weakly decreased investigational drug metabolism in 52 cases (43%, 95% CI 34-51%, and potentially strongly decreased investigational drug metabolism in 17 cases (14%, 95% CI 8-20%. Investigational drug potentially weakly decreased CM metabolism in 39 cases (32%, 95% CI 24-40%, and potentially strongly decreased CM metabolism in 28 cases (23%, 95% CI 15-30%. CM substitution occurred in 36/67 cases (54%, 95% CI 41-66% where CM were discontinued to allow for eventual participation in clinical trials. Overall in 2 cases (0.7%, 95% CI 0.1-2.6%, patients were protocol ineligible because CM could not be discontinued or substituted. Conclusions: This study highlights the high prevalence of

  9. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale. PMID:26802307

  10. EVALUATION OF CONCOMITANT TREATMENT OF SIMVASTATIN AND ZINGIBER OFFICINALE IN DOXORUBICIN INDUCED CARDIOTOXICITY IN WISTAR RATS

    Directory of Open Access Journals (Sweden)

    Khatib N.A

    2011-02-01

    Full Text Available The present study was aimed to evaluate the combined effects of simvastatin (SIM and ethanol extract of Zingiber officinale (ZO in doxorubicin (DOX induced cardiotoxicity in Wistar rats. DOX 10 mg/kg i.p single dose to causes cardiac damage and increases the levels of cardiac biomarker enzymes viz. ALT, AST, LDH and CKMB. In addition, a significant rise in HR, ST- segment and alterations in ECG patterns were observed in DOX treated group. SIM (1.8 mg/kg & 3.6 mg/kg and ZO (200 mg/kg & 400 mg/kg alone and in combination were given to rats as pretreatment for 30 days orally. Pretreatment with SIM and ZO alone significantly (P<0.001 reduced the elevated serum biomarker enzyme levels and ECG alterations in DOX induced cardiotoxic rats. But, combined pretreatment with SIM and ZO normalized the biochemical parameters and ECG changes in DOX induced cardiotoxic rats. The result obtained from the present study indicates concomitant pretreatment of SIM and ZO showed significant improvement than single treatment.

  11. Concomitant binding of Afadin to LGN and F-actin directs planar spindle orientation.

    Science.gov (United States)

    Carminati, Manuel; Gallini, Sara; Pirovano, Laura; Alfieri, Andrea; Bisi, Sara; Mapelli, Marina

    2016-02-01

    Polarized epithelia form by oriented cell divisions in which the mitotic spindle aligns parallel to the epithelial plane. To orient the mitotic spindle, cortical cues trigger the recruitment of NuMA-dynein-based motors, which pull on astral microtubules via the protein LGN. We demonstrate that the junctional protein Afadin is required for spindle orientation and correct epithelial morphogenesis of Caco-2 cysts. Molecularly, Afadin binds directly and concomitantly to F-actin and to LGN. We determined the crystallographic structure of human Afadin in complex with LGN and show that it resembles the LGN-NuMA complex. In mitosis, Afadin is necessary for cortical accumulation of LGN and NuMA above the spindle poles, in an F-actin-dependent manner. Collectively, our results depict Afadin as a molecular hub governing the enrichment of LGN and NuMA at the cortex. To our knowledge, Afadin is the first-described mechanical anchor between dynein and cortical F-actin. PMID:26751642

  12. Coated particle assemblies for the concomitant pulmonary administration of budesonide and salbutamol sulphate.

    Science.gov (United States)

    Raula, Janne; Rahikkala, Antti; Halkola, Tuomas; Pessi, Jenni; Peltonen, Leena; Hirvonen, Jouni; Järvinen, Kristiina; Laaksonen, Timo; Kauppinen, Esko I

    2013-01-30

    The aims were to prepare stable and well-dispersible pulmonary fine powders composed of combination drugs with different water solubility, to facilitate concomitant release of corticosteroid budesonide and short acting β-agonist salbutamol sulphate and to improve the dissolution of the budesonide. The budesonide nanosuspensions were prepared by a wet milling which were mixed then with salbutamol sulphate, mannitol (bulking material) and leucine (coating material) for the preparation of micron-sized particles by an aerosol flow reactor wherein leucine formed a rough coating layer on particle surface. The stable and intact particle assemblies showed excellent aerosolization performance. The emitted doses from the inhaler, Easyhaler(®), were ~3 mg/dose with a coefficient variation of 0.1, and the fine particle fractions were ~50%. Complete dissolution of budesonide nanocrystals from the particles took place within 20 min with the same rate as salbutamol sulphate. Combining the two formulation technologies enabled the encapsulation of drugs with different solubility into a single, intact particle. The leucine coating provided excellent aerosolization properties which allowed fine powder delivery from the inhaler without carrier particles. This study showed the feasibility of preparing powders for combination therapy that are utilized, for instance, in inhalation therapy. PMID:23200957

  13. Chronic Q Fever in Alberta: A Case of Coxiella burnetii Mycotic Aneurysm and Concomitant Vertebral Osteomyelitis

    Directory of Open Access Journals (Sweden)

    William Stokes

    2016-01-01

    Full Text Available Chronic Q fever is a potentially life-threatening infection from the intracellular, Gram-negative Coxiella burnetii. It presents most commonly as endocarditis or vascular infection in people with underlying cardiac or vascular disease. We discuss a case of a 67-year-old male with Coxiella burnetii vascular infection of a perirenal abdominal aortic graft. The patient had a history of an abdominal aortic aneurysm (AAA repair 5 years earlier. He presented with a 12 × 6 × 8 cm perirenal pseudoaneurysm and concomitant L1, L2, and L3 vertebral body discitis. He underwent an open repair which revealed a grossly infected graft perioperatively. Q fever serology revealed phase I serological IgG titer of 1 : 2048 and phase II 1 : 1024 consistent with chronic Q fever. Polymerase chain reaction (PCR on infected vascular tissue was positive for C. burnetii. The patient was started on doxycycline and hydroxychloroquine with good clinical response and decreasing serological titers. Recognizing chronic Q fever is a difficult task as symptoms are nonspecific, exposure risk is difficult to ascertain, and diagnosis is hidden from conventional microbiological investigations. Its recognition, however, is critical as C. burnetii is inherently resistant to standard empiric therapies used in cardiovascular infections.

  14. Are we justified for concomitant chemo-radiation in advanced stage cancer cervix?

    International Nuclear Information System (INIS)

    the survival rates have achieved a plateau of 30-45% at five years. Over the last decade there have been studies on the use of chemo-radiotherapy in carcinoma cervix. Over 19 randomized trials have been published addressing the issue of chemo-radiotherapy. However, heterogeneous data, poor randomization, inadequate number of patients, sub-optimal radiotherapy, non-uniform use of chemotherapeutic drugs, its sequencing and poor documentation have not yet provided the evidence to substantially alter the practice. The Cochrane and Canadian meta-analyses have to a large extent tried to address the role of concomitant chemo-radiation, but carcinoma cervix stage III accounted for only 30?35%. Moreover, evaluation with optimal radiation schedules and comparison of late toxicities still remain unanswered. What is more important is that the cisplatin is relatively inexpensive and is available worldwide. This means that cisplatin-based chemo-radiation is affordable in the developing countries where carcinoma cervix still forms the major cancer. However, the role of chemo-radiation in carcinoma cervix stage IIIB in developing countries including India still remains unexplored. With an aim to evaluate the role and benefit of chemo-radiation in- patients with cervical cancer we proposed this randomized study

  15. Concomitant Colonization of Helicobacter pylori in Dental Plaque and Gastric Biopsy

    Directory of Open Access Journals (Sweden)

    Amin Talebi Bezmin Abadi

    2014-01-01

    Full Text Available Frequently reported H. pylori antimicrobial therapy failures suggest that there might be a different niche where the bacteria can stay safe. Current study aims to examine potential role of oral colonization of H. pylori to feed reinfection after primary therapy. However, patients who were admitted to the gastroscopy section were chosen and gastric biopsy and dental plaque specimens were collected. Molecular and biochemical tests were applied to confirm H. pylori identity in different colonization niches. Results showed that 88.8% of dyspeptic patients had epigastric pains with nocturnal awakening when they were hungry (P=0.023. All patients who received therapy already were again H. pylori positive while they are still carrying H. pylori in dental plaque (P=0.001. Moreover, H. pylori infection was sought in 100% of gastric biopsy’s dyspeptic patients who had ulcerated esophagitis and erosive duodenitis and who were H. pylori positive, and 75% of dyspeptic patients with duodenum deformity had this bacterium in gastric biopsies (P=0.004. Present study showed that only successful eradication of gastric H. pylori cannot guarantee prevention of reinfection. Conclusively, a new strategy which indicates concomitant eradication in oral and gastric colonization can result in clearance of H. pylori infection.

  16. Coronary revascularization in lung transplant recipients with concomitant coronary artery disease.

    Science.gov (United States)

    Castleberry, A W; Martin, J T; Osho, A A; Hartwig, M G; Hashmi, Z A; Zanotti, G; Shaw, L K; Williams, J B; Lin, S S; Davis, R D

    2013-11-01

    Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible. PMID:24102830

  17. Cisplatin-induced premature senescence with concomitant reduction of gap junctions in human fibroblasts

    Institute of Scientific and Technical Information of China (English)

    Wei ZHAO; Zhong Xiang LIN; Zhi Qian ZHANG

    2004-01-01

    To examine the role of gap junctions in cell senescence,the changes of gap junctions in cisplatin-induced premature senescence of primary cultured fibroblasts were studied and compared with the replicative senescent human fibroblasts.Dye transfer assay for gap junction function and immunofluorescent staining for connexin 43 protein distribution were done respectively. Furthermore,cytofluorimetry and DAPI fluorescence staining were performed for cell cycle and apoptosis analysis. p53 gene expression level was detected with indirect immunofluorescence. We found that cisplatin (10 mM) treatment could block cell growth cycle at G1 and induced premature senescence. The premature senescence changes included high frequency of apoptosis,elevation of p53 expression,loss of membranous gap junctions and reduction of dye-transfer capacity. These changes were comparable to the changes of replicative senescence of human fibroblasts. It was also concluded that cisplatin could induce premature senescence concomitant with inhibition of gap junctions in the fibroblasts. Loss of functional gap junctions from the cell membrane may account for the reduced intercellular communication in the premature senescent fibroblasts. The cell system we used may provide a model useful for the study of the gap junction thus promoting agents against premature senescence.

  18. Concomitant extracellular accumulation of alpha-keto acids and higher alcohols by Zygosaccharomyces rouxii.

    Science.gov (United States)

    Van Der Sluis, Catrinus; Rahardjo, Yovita S P; Smit, Bart A; Kroon, Pieter J; Hartmans, Sybe; Ter Schure, Eelko G; Tramper, Johannes; Wijffels, Renéh

    2002-01-01

    Alpha-keto acids are key intermediates in the formation of higher alcohols, important flavor components in soy sauce, and produced by the salt-tolerant yeast Zygosaccharomyces rouxii. Unlike most of the higher alcohols, the alpha-keto acids are usually not extracellularly accumulated by Z. rouxii when it is cultivated with ammonium as the sole nitrogen source. To facilitate extracellular accumulation of the alpha-keto acids from aspartate-derived amino acid metabolism, the amino acids valine, leucine, threonine and methionine were exogenously supplied during batch and A-star cultivations of (routants of) Z. rouxii. It was shown that all alpha-keto acids from the aspartate-derived amino acid metabolism, except alpha-ketobutyrate, could be extracellularly accumulated. In addition, it appeared from the concomitant extracellular accumulation of alpha-keto acids and higher alcohols that in Z. rouxii, valine, leucine and methionine were converted via Ehrlich pathways similar to those in Saccharomyces cerevisiae. Unlike these amino acids, threonine was converted via both the Ehrlich and amino acid biosynthetic pathways in Z. rouxii. PMID:16233175

  19. Surgical Success Rates for Horizontal Concomitant Deviations According to the Type and Degree of Deviation

    Directory of Open Access Journals (Sweden)

    İhsan Çaça

    2004-01-01

    Full Text Available We evaluated the correlation with success rates and deviation type and degree inhorizontal concomitant deviations. 104 horizontal concomitan strabismus cases whowere operated in our clinic between January 1994 – December 2000 were included in thestudy. 56 cases undergone recession-resection procedure in the same eye 19 cases twomuscle recession and one muscle resection, 20 cases two muscle recession, 9 cases onlyone muscle recession. 10 ± prism diopter deviation in postoperative sixth monthexamination was accepted as surgical success.Surgical success rate was 90% and 89.3% in the cases with deviation angle of 15-30and 31-50 prism diopter respectively. Success rate was 78.9% if the angle was more than50 prism diopter. According to strabismus type when surgical success rate examined; inalternan esotropia 88.33%, in alternan exotropia 84.6%, in monocular esotropia 88%and in monocular exotropia 83.3% success was fixed. Statistically significant differencewas not found between strabismus type and surgical success rate. The binocular visiongaining rate was found as 51.8% after the treatment of cases.In strabismus surgery, preoperative deviation angle was found to be an effectivefactor on the success rate.

  20. Chronic Q Fever in Alberta: A Case of Coxiella burnetii Mycotic Aneurysm and Concomitant Vertebral Osteomyelitis.

    Science.gov (United States)

    Stokes, William; Janvier, Jack; Vaughan, Stephen

    2016-01-01

    Chronic Q fever is a potentially life-threatening infection from the intracellular, Gram-negative Coxiella burnetii. It presents most commonly as endocarditis or vascular infection in people with underlying cardiac or vascular disease. We discuss a case of a 67-year-old male with Coxiella burnetii vascular infection of a perirenal abdominal aortic graft. The patient had a history of an abdominal aortic aneurysm (AAA) repair 5 years earlier. He presented with a 12 × 6 × 8 cm perirenal pseudoaneurysm and concomitant L1, L2, and L3 vertebral body discitis. He underwent an open repair which revealed a grossly infected graft perioperatively. Q fever serology revealed phase I serological IgG titer of 1 : 2048 and phase II 1 : 1024 consistent with chronic Q fever. Polymerase chain reaction (PCR) on infected vascular tissue was positive for C. burnetii. The patient was started on doxycycline and hydroxychloroquine with good clinical response and decreasing serological titers. Recognizing chronic Q fever is a difficult task as symptoms are nonspecific, exposure risk is difficult to ascertain, and diagnosis is hidden from conventional microbiological investigations. Its recognition, however, is critical as C. burnetii is inherently resistant to standard empiric therapies used in cardiovascular infections. PMID:27366178

  1. Increase of malaria attacks among children presenting concomitant infection by Schistosoma mansoni in Senegal

    Directory of Open Access Journals (Sweden)

    Diop Mamadou

    2004-11-01

    Full Text Available Abstract Helminthic infections concomitant with malaria are common in inter-tropical areas. A recent study showed that mice co-infected with Schistosoma mansoni and Plasmodium chabaudi develop higher P. chabaudi parasitaemia and had a higher mortality rate. This important observation deserved to be further investigated among human populations. Malaria attacks were recorded in 512 children aged 6–15 years living in Richard Toll (Northern Senegal among whom 336 were infected by S. mansoni, and 175 were not. The incidence rate of malaria attacks was significantly higher among S. mansoni-infected individuals, particularly those carrying the highest worm loads, as compared to uninfected subjects (26.6% versus 16,4 %. In contrast, the rate of malaria attacks was lower, without reaching significance, in medium grade S. mansoni infections. Thus, infection by S. mansoni affects susceptibility to malaria, but this can vary according to the intensity of parasite load. The immunological mechanisms underlying this dual effect need to be further explored.

  2. Increase of malaria attacks among children presenting concomitant infection by Schistosoma mansoni in Senegal

    Science.gov (United States)

    Sokhna, Cheikh; Le Hesran, Jean-Yves; Mbaye, Pape A; Akiana, Jean; Camara, Pape; Diop, Mamadou; Ly, Abdoulaye; Druilhe, Pierre

    2004-01-01

    Helminthic infections concomitant with malaria are common in inter-tropical areas. A recent study showed that mice co-infected with Schistosoma mansoni and Plasmodium chabaudi develop higher P. chabaudi parasitaemia and had a higher mortality rate. This important observation deserved to be further investigated among human populations. Malaria attacks were recorded in 512 children aged 6–15 years living in Richard Toll (Northern Senegal) among whom 336 were infected by S. mansoni, and 175 were not. The incidence rate of malaria attacks was significantly higher among S. mansoni-infected individuals, particularly those carrying the highest worm loads, as compared to uninfected subjects (26.6% versus 16,4 %). In contrast, the rate of malaria attacks was lower, without reaching significance, in medium grade S. mansoni infections. Thus, infection by S. mansoni affects susceptibility to malaria, but this can vary according to the intensity of parasite load. The immunological mechanisms underlying this dual effect need to be further explored. PMID:15544703

  3. [Case of systemic myositis and subacute sensory neuropathy concomitant with signet-ring cell carcinoma].

    Science.gov (United States)

    Yasuda, Chiharu; Yakushiji, Yusuke; Tokunaga, Osamu; Hara, Hideo; Nishino, Ichizo

    2010-04-01

    A 72-year-old woman referred to our hospital because of slowly progressive (over 2 years) muscle weakness and paresthesias of the lower limbs. On neurological examination, weakness and muscle atrophies were noted in the distal upper limbs as well as the proximal lower limbs. She had also paresthesias of the legs. The level of creatinine phosphokinase (CK) was 126 IU/l. The magnetic resonance imaging demonstrated gadolinium enhancement of the nerve roots at the L4-S2 vertebrate levels. Nerve conduction study showed decreased compound muscle action potential and motor conduction velocity of tibial and peroneal nerves. Biopsy of the left biceps brachii muscle showed variations in fiber size, endomysial mononuclear cell infiltration and the findings like a rimmed vacuole. Although almost of her findings were in accord with clinical features of inclusion body myositis, strong inflammatory cellular influences allowed us to administer corticosteroid therapy. Because her weakness was well responded to steroid therapy, polymyositis was considered as differential diagnosis. Then, further examinations were investigated to search any occult neoplasm, and detected the early gastric cancer. Total gastrectomy was performed later, and the pathological diagnosis was made as a signet-ring cell carcinoma. To our knowledge, this is the first report of systemic myositis and subacute sensory neuropathy concomitant with signet-ring cell carcinoma. These symptoms might be occurred as a result of paraneoplastic syndrome associated with satellite effects of the signet-ring cell carcinoma. PMID:20411807

  4. Outcomes in Newly Diagnosed Elderly Glioblastoma Patients after Concomitant Temozolomide Administration and Hypofractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Ludovic T. [Neurology Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Touch, Socheat [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Nehme-Schuster, Hélène [Oncology Geriatric Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Antoni, Delphine [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Eav, Sokha [Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Clavier, Jean-Baptiste; Bauer, Nicolas; Vigneron, Céline [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Schott, Roland [Oncology Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Kehrli, Pierre [Neurosurgery Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Noël, Georges, E-mail: gnoel@strasbourg.unicancer.fr [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Laboratoire EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000 (France)

    2013-09-24

    This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O{sub 6}-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.

  5. Outcomes in Newly Diagnosed Elderly Glioblastoma Patients after Concomitant Temozolomide Administration and Hypofractionated Radiotherapy

    International Nuclear Information System (INIS)

    This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals

  6. Daily amifostine given concomitantly to chemoradiation in head and neck cancer. A pilot study

    International Nuclear Information System (INIS)

    Background: In patients with loco-regionally advanced head and neck cancer conventionally fractionated radiotherapy alone results in poor loco-regional control and survival rates. Treatment intensification by simultaneous administration of cytotoxic drugs produces higher acute morbidity. Therefore chemical radioprotection of normal tissues may be of clinical benefit. Patients and Methods: In a pilot study patients with advanced nonresectable head neck cancer treated with conventionally fractionated radical radiotherapy (60 to 66 Gy total doses) and concomitantly given 5-fluorouracil as protracted venous infusion, 250 mg/sqm/24 h over the entire treatment period were given amifostine 300 mg absolutely before each fraction. Acute treatment related mobidity was scored according to CTC classification and loco-regional control and survival rates were estimated. Comparison was made with a historical control group of identical chemoradiation but without amifostine application. Results: Chemoradiation induced oral mucositis was delayed and showed significant lower degrees at all 10 Gy increments (p0.05). No significant toxicity was recorded with respect to blood pressure, serum calcium, potassium, hematologic parameters, emesis, nausea or body weight loss. Progression free survival and overall survival probability at 2 years were not statistically different in both cohorts. Conclusion: Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed. (orig.)

  7. FASTR: A novel data format for concomitant representation of RNA sequence and secondary structure information

    Indian Academy of Sciences (India)

    Tungadri Bose; Anirban Dutta; Mohammed Mh; Hemang Gandhi; Sharmila S Mande

    2015-09-01

    Given the importance of RNA secondary structures in defining their biological role, it would be convenient for researchers seeking RNA data if both sequence and structural information pertaining to RNA molecules are made available together. Current nucleotide data repositories archive only RNA sequence data. Furthermore, storage formats which can frugally represent RNA sequence as well as structure data in a single file, are currently unavailable. This article proposes a novel storage format, `FASTR’, for concomitant representation of RNA sequence and structure. The storage efficiency of the proposed FASTR format has been evaluated using RNA data from various microorganisms. Results indicate that the size of FASTR formatted files (containing both RNA sequence as well as structure information) are equivalent to that of FASTA-format files, which contain only RNA sequence information. RNA secondary structure is typically represented using a combination of a string of nucleotide characters along with the corresponding dot-bracket notation indicating structural attributes. `FASTR’ – the novel storage format proposed in the present study enables a frugal representation of both RNA sequence and structural information in the form of a single string. In spite of having a relatively smaller storage footprint, the resultant `fastr’ string(s) retain all sequence as well as secondary structural information that could be stored using a dot-bracket notation. An implementation of the `FASTR’ methodology is available for download at http://metagenomics.atc.tcs.com/compression/fastr.

  8. CONCOMITANT FORMS OF ABUSE AND HELP-SEEKING BEHAVIOR AMONG WHITE, AFRICAN AMERICAN, AND LATINA WOMEN WHO EXPERIENCE INTIMATE PARTNER VIOLENCE

    OpenAIRE

    Flicker, Sharon M.; Cerulli, Catherine; Zhao, Xi; Tang, Wan; Watts, Arthur; Xia, Yinglin; Talbot, Nancy L.

    2011-01-01

    This study uses National Violence against Women Survey data to investigate the differential impact of concomitant forms of violence (sexual abuse, stalking, and psychological abuse) and ethnicity on help-seeking behaviors of women physically abused by an intimate partner (n=1,756). Controlling for severity of the physical abuse, women who experienced concomitant sexual abuse were less likely to seek help, women who experienced concomitant stalking were more likely to seek help, whereas concom...

  9. Effect of xenobiotics on the respiratory activity of rat heart mitochondria and the concomitant formation of superoxide radicals

    Energy Technology Data Exchange (ETDEWEB)

    Stolze, K.; Nohl, H. (Univ. of Vienna (Austria). Inst. of Pharmacology and Toxicology)

    1994-03-01

    The effects of the xenobiotics atrazine, benzene, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lindane, toluene, and xylenol on the respiration of isolated rate heart mitochondria were studied. Bioenergetic parameters such as respiratory control (RC) and ATP/oxygen (P/O) values decreased considerably in the presence of these substances, and a concomitant increase of superoxide radical (O[sub 2][sup [minus

  10. Concomitant consumption of lycopene and fish oil inhibits tumor growth and progression in a mouse xenograft model of colon cancer

    Science.gov (United States)

    Our previous report showed that concomitant supplementation of lycopene and eicosa-pentaenoic acid synergistically inhibited the proliferation of human colon cancer HT-29 cells in vitro. To validate our findings, the present study investigated whether consumption of lycopene and fish oil would help ...

  11. Cell-associated HIV DNA measured early during infection has prognostic value independent of serum HIV RNA measured concomitantly

    DEFF Research Database (Denmark)

    Katzenstein, Terese L; Oliveri, Roberto S; Benfield, Thomas;

    2002-01-01

    Using data from the Danish AIDS Cohort of HIV-infected homosexual men established in the 1980s, the prognostic value of early HIV DNA loads was evaluated. In addition to DNA measurements, concomitant serum HIV RNA levels, CD4 cell counts and CCR5 genotypes were determined. The patients were divided...

  12. 研究卡培他滨和替吉奥单药治疗老年晚期乳腺癌的临床疗效及安全性比较%Study and comparison of clinical curative effect and safety of capecitabine and S-1 for elderly patients with advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    肖妤; 胡纲

    2016-01-01

    Objective to observe and compare clinical curative effect and safety of capecitabine and S-1 for elderly patients with advanced breast cancer.Methods choose 70 cases elderly patients with advanced breast cancer treated in our hospital from January 2014 to January 2016, divide them into two groups, 35 cases in each. Group 1 was treated with capecitabine, and group 2 with S-1 only. Compare two groups with complete remission rate, disease control rate and adverse reaction rate after treatment.Results complete remission rate of S-1 group was 55.6%, significantly higher than 35.1% of capecitabine group (P 0.05), but adverse reactions high incidence of leukopenia, nausea and vomiting, hand foot syndrome of capecitabine group were much more serious than S-1 group (P 0.05),而白细胞减少、恶心呕吐、手足综合症等不良反应情况,卡培他滨组明显比替吉奥组严重,发生率高,(P<0.05),差异具有统计学意义。结论通过临床治疗效果和安全范围的比较,替吉奥单药治疗老年晚期乳腺癌明显比卡培他滨的疗效好,不良反应轻,值得在临床上进一步研究、推广。

  13. 卡培他滨维持治疗在激素受体阴性晚期乳腺癌中的临床观察%Clinical observation of Capecitabine maintenance treatment in hormone receptor-negative metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    吴凡; 刘健

    2014-01-01

    目的:观察卡培他滨维持治疗激素受体阴性转移性乳腺癌的近期、远期疗效及不良反应方法:对一线化疗疾病获得控制的晚期转移性乳腺癌予卡培他滨单药维持化疗直至疾病进展结果:卡培他滨维持化疗总有效率(CR+PR)为10.5%,肿瘤控制率(CR+PR+SD)为52.6%。中位疾病进展时间(mTTP)为13.4个月。主要不良反应为白细胞减少、手足综合征及口腔黏膜炎结论:卡培他滨维持治疗在转移性乳腺癌中疗效肯定,不良反应可耐受。%Objective: To explore the efficacy and adverse reactions of capecitabine in the maintenance treatment of hormone receptor-negative metastatic breast cancer. methods: Metastatic breast cancer patients who gain control by first-line chemotherapy was treated by capecitabine monotherapy maintenance regiment until disease progression. Results: Total effective rate (CR + PR) was 10.5%, the tumor control rate (CR + PR + SD) was 52.6% and median time to progression (mTTP) was 13.4 months in metastatic breast cancer patients treated by capecitabine maintenance chemotherapy. The main adverse events were hand-foot syndrome, leukopenia and mucositis Conclusion: Capecitabine maintenance therapy has a definite curative effect in metastatic breast cancer, which adverse reactions can be tolerated.

  14. Phase 1/2 study of valproic acid and short-course radiotherapy plus capecitabine as preoperative treatment in low-moderate risk rectal cancer-V-shoRT-R3 (Valproic acid - short RadioTherapy - rectum 3rd trial)

    OpenAIRE

    Avallone, Antonio; Piccirillo, Maria Carmela; Delrio, Paolo; Pecori, Biagio; Di Gennaro, Elena; Aloj, Luigi; Tatangelo, Fabiana; D’Angelo, Valentina; Granata, Cinzia; Cavalcanti, Ernesta; Maurea, Nicola; Maiolino, Piera; Bianco, Franco; Montano, Massimo; Silvestro, Lucrezia

    2014-01-01

    Background Locally advanced rectal cancer (LARC) is a heterogeneous group of tumors where a risk-adapted therapeutic strategy is needed. Short-course radiotherapy (SCRT) is a more convenient option for LARC patients than preoperative long-course RT plus capecitabine. Histone-deacetylase inhibitors (HDACi) have shown activity in combination with RT and chemotherapy in the treatment of solid tumors. Valproic acid (VPA) is an anti-epileptic drug with HDACi and anticancer activity. In preclinical...

  15. Risk factors of radiation-induced acute esophagitis in non-small cell lung cancer patients treated with concomitant chemoradiotherapy

    International Nuclear Information System (INIS)

    To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy. Seventy-six NSCLC patients treated with concomitant chemoradiotherapy were retrospectively analyzed. Forty-one patients received concomitant chemoradiotherapy with vinorelbine/cisplatin (VC), 35 with docetaxel/cisplatin (DC). AE was graded according to criteria of the Radiation Therapy Oncology Group (RTOG). The following clinical and dosimetric parameters were analyzed: gender, age, clinical stage, Karnofsky performance status (KPS), pretreatment weight loss, concomitant chemotherapy agents (CCA) (VC vs. DC), percentage of esophagus volume treated to ≥20 (V20), ≥30 (V30), ≥40 (V40), ≥50 (V50) and ≥60 Gy (V60), and the maximum (Dmax) and mean doses (Dmean) delivered to esophagus. Univariate and multivariate logistic regression analysis were used to test the association between the different factors and AE. Seventy patients developed AE (Grade 1, 19 patients; Grade 2, 36 patients; and Grade 3, 15 patients). By multivariate logistic regression analysis, V40 was the only statistically significant factor associated with Grade ≥2 AE (p<0.001, OR = 1.159). A V40 of <23% had a 33.3% (10/30) risk of Grade ≥2 AE, which increased to 89.1% (41/46) with a V40 of ≥23% (p<0.001). CCA (p =0.01; OR = 9.686) and V50 (p<0.001; OR = 1.122) were most significantly correlated with grade 3 AE. A V50 of <26.5% had a 6.7% (3/45) risk of Grade 3 AE, which increased to 38.7% (12/31) with a V50 of ≥26.5% (p = 0.001). On the linear regression analysis, V50 and CCA were significant independent factors affecting AE duration. Patients who received concomitant chemotherapy with VC had a decreased risk of grade 3 AE and shorter duration compared with DC. Concomitant chemotherapy agents have potential influence on AE. Concomitant chemotherapy with VC led to lower risk of AE compared with that using DC. V40 and V50

  16. 中等剂量卡培他滨单药治疗老年转移性乳腺癌临床探讨%Clinical Observation of Median Dose of Capecitabine in Treatment of Elder-ly Patients with Metastatic Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    王红丽

    2016-01-01

    Objective To observe the treatment effect and toxic and side effect of moderate dose of capecitabine in treat-ment of elderly patients with metastatic breast cancer. Methods 76 cases of elderly patients with metastatic breast cancer treated in our hospital from March 2012 to February 2014 were selected and randomly divided into control group and treat-ment group with 38 cases in each, the control group were given large dose of capecitabine, the treatment group were given median dose of capecitabine, the treatment effects and toxic and side effects of the two groups were observed. Results There was no obvious difference in the total effective rate and tumor control rate between the treatment group and the control group (P>0.05); toxic and side effects in the treatment group were obviously fewer than those in the control group, and the difference was significant (P0.05);治疗组患者的不良反应明显少于对照组患者,差异有统计学意义(P<0.05). 结论 中等剂量卡培他滨单药治疗老年转移性乳腺癌的效果较好,且不良反应较小,值得临床推广.

  17. Salvage surgery for local recurrence after concomitant radiotherapy and superselective arterial infusion of cisplatin in patients with squamous cell carcinoma cancer of the maxillary sinus

    International Nuclear Information System (INIS)

    This retrospective study aimed to assess the role of salvage surgery for local recurrence after concomitant radiotherapy and superselective arterial infusion of cisplatin (RADPLAT) in patients with squamous cell carcinoma cancer of the maxillary sinus as an initial treatment. Forty-one patients were treated by RADPLAT between 1999 and 2009. Local recurrence in the primary site was observed in 12 patients of whom 9 could undergo further salvage surgery. Primary disease control was achieved in 7 of these patients (successful salvage rate, 58.3%). Successful salvage rates for T3, T4a and T4b primary disease were 66.7% (2/3), 66.7% (4/6) and 33.3% (1/3), respectively. The 5-year overall survival rate was 73.6% in all patients. Severe postoperative complication was seen in one patient. Prognosis of patients with locally recurring maxillary sinus squamous cell carcinoma after RADPLAT is relatively good. This is because residual/recurrent tumor was located in anterior portion of the face in most cases. This result should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined. (author)

  18. Does the information content of payout initiations and omissions influence firm risks?

    NARCIS (Netherlands)

    Goyal, Abhinav; Muckley, Cal B.; von Eije, Johan

    2014-01-01

    We study the influence on firm risks of NASDAQ and NYSE firm payout initiations and omissions. These payout events can be interpreted as managerial signals of firm financial life-cycle maturation resulting in concomitant changes in firm risks. We remove confounding payout types and we match on the p

  19. MC1R variants predisposing to concomitant primary cutaneous melanoma in a monozygotic twin pair

    Directory of Open Access Journals (Sweden)

    Pellegrini Cristina

    2012-09-01

    Full Text Available Abstract Background Concomitant primary cutaneous melanoma in monozygotic twins has been reported in only two pairs but in neither of them genetic analysis was performed. Two high-penetrance susceptibility genes, CDKN2A and CDK4 and one low-penetrance gene, MC1R, are well-defined genetic risk factors for melanoma. MITF has been recently identified as a novel intermediate risk melanoma-predisposing gene. Case presentation We describe the extraordinary occurrence of a primary cutaneous invasive melanoma in two 44-year-old identical, female twins, on the same body site within 30 days of each other and report for the first time the genetic analysis of melanoma susceptibility genes in both twins. Data on characteristics of the twins were collected through a standardized questionnaire and skin examination. Exons 1α, 1β, 2 and 3 of CDKN2A, exon 2 of CDK4, the entire open reading frame of MC1R and the recently described MITF c.952 G > A (p.Glu318Lys variant were investigated by direct sequencing. Sequencing analysis of the high-penetrance susceptibility genes showed no changes in CDKN2A and in exon 2 of the CDK4 gene. Both patients were heterozygous for the same CDKN2A UTR c.*29C > G variant. Interestingly, the same two heterozygous variants of the MC1R were identified in both twins: the c.451C > T (p.Arg151Cys and the c.456C > A (p.Tyr152* variants. Neither patient showed the c.952 G > A (p.Glu318Lys substitution in the MITF gene. Conclusions Identification of two high-risk MC1R variants in our identical twins in the absence of CDKN2A and CDK4 mutations highlights the contribution of low penetrance genes, such as MC1R, in melanoma susceptibility.

  20. Paclitaxel and concomitant radiotherapy in high-risk endometrial cancer patients: preliminary findings

    International Nuclear Information System (INIS)

    There is still much debate about the best adjuvant therapy after surgery for endometrial cancer (EC) and there are no current guidelines. Radiotherapy (RT) alone does not seem to improve overall survival. We investigated whether concomitant Paclitaxel (P) and RT gave better clinical results. Twenty-three patients with high-risk EC (stage IIB, IIIA, IIIC or IC G3 without lymphadenectomy or with aneuploid tumor) underwent primary surgery and were then referred for adjuvant therapy. P was given at a dose of 60 mg/m2 once weekly for five weeks during RT, which consisted of a total radiation dose of 50.4 Gy. Three further weekly cycles of P at a dose of 80 mg/m2 were given at the end of RT. Overall survival and disease-free survival were calculated from the time of surgery. Patterns of failure were recorded by the sites of failure. A total of 157 cycles of P were administered both during radiotherapy and consolidation chemotherapy. Relapses occurred in five patients (21.7%). Median time to recurrence was 18.6 months (range 3–28). Survival rate for all the patients was 78.2%. Overall survival for the patients who completed chemo-radiation was of 81%. In this group median time to recurrence was 19.2 months (range 3–28). All recurrences were outside the radiation field. Mortality rate was 14.2%. This small series demonstrates pelvic radiotherapy in combination with weakly P followed by three consolidation chemotherapy cycles as an effective combined approach in high risk endometrial carcinoma patients

  1. Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study.Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

  2. Carbapenem-Resistant Acinetobacter baumannii: Concomitant Contamination of Air and Environmental Surfaces.

    Science.gov (United States)

    Shimose, Luis A; Masuda, Eriko; Sfeir, Maroun; Berbel Caban, Ana; Bueno, Maria X; dePascale, Dennise; Spychala, Caressa N; Cleary, Timothy; Namias, Nicholas; Kett, Daniel H; Doi, Yohei; Munoz-Price, L Silvia

    2016-07-01

    OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of air samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 13.1% of air samples were positive (P=.0001). In rooms with rectally colonized patients, 15.5% of environmental samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 9.5% of environmental samples were positive (P=.02). The rates of air contamination in the open-layout and single-occupancy ICUs were 17.9% and 21.8%, respectively (P=.5). Environmental surfaces were positive in 9.5% of instances in open-layout ICUs versus 13.4% in single-occupancy ICUs (P=.09). CONCLUSIONS Air and environmental surface contaminations were significantly greater among rectally colonized patients; however, ICU layout did not influence the rate of contamination. Infect Control Hosp Epidemiol 2016;37:777-781. PMID:27045768

  3. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial

  4. Concomitant duplications of opioid peptide and receptor genes before the origin of jawed vertebrates.

    Directory of Open Access Journals (Sweden)

    Görel Sundström

    Full Text Available BACKGROUND: The opioid system is involved in reward and pain mechanisms and consists in mammals of four receptors and several peptides. The peptides are derived from four prepropeptide genes, PENK, PDYN, PNOC and POMC, encoding enkephalins, dynorphins, orphanin/nociceptin and beta-endorphin, respectively. Previously we have described how two rounds of genome doubling (2R before the origin of jawed vertebrates formed the receptor family. METHODOLOGY/PRINCIPAL FINDINGS: Opioid peptide gene family members were investigated using a combination of sequence-based phylogeny and chromosomal locations of the peptide genes in various vertebrates. Several adjacent gene families were investigated similarly. The results show that the ancestral peptide gene gave rise to two additional copies in the genome doublings. The fourth member was generated by a local gene duplication, as the genes encoding POMC and PNOC are located on the same chromosome in the chicken genome and all three teleost genomes that we have studied. A translocation has disrupted this synteny in mammals. The PDYN gene seems to have been lost in chicken, but not in zebra finch. Duplicates of some peptide genes have arisen in the teleost fishes. Within the prepropeptide precursors, peptides have been lost or gained in different lineages. CONCLUSIONS/SIGNIFICANCE: The ancestral peptide and receptor genes were located on the same chromosome and were thus duplicated concomitantly. However, subsequently genetic linkage has been lost. In conclusion, the system of opioid peptides and receptors was largely formed by the genome doublings that took place early in vertebrate evolution.

  5. Adiponectin gene polymorphism is selectively associated with the concomitant presence of metabolic syndrome and essential hypertension.

    Directory of Open Access Journals (Sweden)

    Hsin-Bang Leu

    Full Text Available OBJECTIVE: Cardiovascular risk increases with the presence of both metabolic syndrome (MetS and hypertension (HTN. Although the adiponectin (ADIPOQ gene has been reported to be involved in MetS, its association with HTN remained undetermined. This study aimed to investigate the association of ADIPOQ gene with the phenotypes of HTN and MetS. METHODS: A total of 962 participants from 302 families from the Taiwan young-onset hypertension genetic study were enrolled. Plasma adiponectin were measured, and association analysis was conducted by using GEE regression-based method. Another study, of 1448 unrelated participants, was conducted to replicate the association between ADIPOQ gene and variable phenotypes of MetS with or without HTN. RESULTS: Among 962 subjects from family samples, the lowest plasma adiponectin value was observed in MetS with HTN component (9.3±0.47 µg/ml compared with hypertensives (13.4±0.74 µg /ml or MetS without HTN (11.9±0.60 µg/ml, P<0.05. The SNP rs1501299 (G276T in ADIPOQ gene was found associated with the presence of HTN in MetS (odds ratio for GG+GT vs. TT = 2.46; 95% CI: 1.14-5.3, p = 0.02, but not rs2241766 (T45G. No association of ADIPOQ gene with HTN alone or MetS without HTN was observed. The significant association of the SNP rs1501299 (G276T with the phenotype of presence of HTN in MetS was confirmed (odds ratio for GG+GT vs. TT = 2.15; 95% CI: 1.1-4.3 in the replication study. CONCLUSIONS: ADIPOQ genetic variants were selectively and specifically associated with the concomitant presence of MetS and HTN, suggesting potential genetic linkage between MetS and HTN.

  6. AR-12 Inhibits Multiple Chaperones Concomitant With Stimulating Autophagosome Formation Collectively Preventing Virus Replication.

    Science.gov (United States)

    Booth, Laurence; Roberts, Jane L; Ecroyd, Heath; Tritsch, Sarah R; Bavari, Sina; Reid, St Patrick; Proniuk, Stefan; Zukiwski, Alexander; Jacob, Abraham; Sepúlveda, Claudia S; Giovannoni, Federico; García, Cybele C; Damonte, Elsa; González-Gallego, Javier; Tuñón, María J; Dent, Paul

    2016-10-01

    We have recently demonstrated that AR-12 (OSU-03012) reduces the function and ATPase activities of multiple HSP90 and HSP70 family chaperones. Combined knock down of chaperones or AR-12 treatment acted to reduce the expression of virus receptors and essential glucosidase proteins. Combined knock down of chaperones or AR-12 treatment inactivated mTOR and elevated ATG13 S318 phosphorylation concomitant with inducing an endoplasmic reticulum stress response that in an eIF2α-dependent fashion increased Beclin1 and LC3 expression and autophagosome formation. Over-expression of chaperones prevented the reduction in receptor/glucosidase expression, mTOR inactivation, the ER stress response, and autophagosome formation. AR-12 reduced the reproduction of viruses including Mumps, Influenza, Measles, Junín, Rubella, HIV (wild type and protease resistant), and Ebola, an effect replicated by knock down of multiple chaperone proteins. AR-12-stimulated the co-localization of Influenza, EBV and HIV virus proteins with LC3 in autophagosomes and reduced viral protein association with the chaperones HSP90, HSP70, and GRP78. Knock down of Beclin1 suppressed drug-induced autophagosome formation and reduced the anti-viral protection afforded by AR-12. In an animal model of hemorrhagic fever virus, a transient exposure of animals to low doses of AR-12 doubled animal survival from ∼30% to ∼60% and suppressed liver damage as measured by ATL, GGT and LDH release. Thus through inhibition of chaperone protein functions; reducing the production, stability and processing of viral proteins; and stimulating autophagosome formation/viral protein degradation, AR-12 acts as a broad-specificity anti-viral drug in vitro and in vivo. We argue future patient studies with AR-12 are warranted. J. Cell. Physiol. 231: 2286-2302, 2016. © 2016 Wiley Periodicals, Inc. PMID:27187154

  7. Node-negative T1–T2 anal cancer: Radiotherapy alone or concomitant chemoradiotherapy?

    International Nuclear Information System (INIS)

    Purpose: To evaluate the influence of concomitant chemotherapy on loco-regional control (LRC) and cancer-specific survival (CSS) in patients with T1–T2 N0 M0 anal cancer treated conservatively by primary radiotherapy (RT). Materials and methods: Between 1976 and 2008, 146 patients with T1 (n = 29) or T2 (n = 117) N0 M0 anal cancer were treated curatively by RT alone (n = 71) or by combined chemoradiotherapy (CRT) (n = 75) consisting of mitomycin C ± 5-fluorouracil. Univariate and multivariate analyses were performed to assess patient-, tumor- and treatment-related factors influencing LRC and CSS. Results: With a median follow-up of 62.5 months (interquartilerange, 26–113 months), 122 (84%) patients were locally controlled. The five-year actuarial LRC, CSS and overall survival for the population were 81.4% ± 3.6%, 91.9% ± 2.6%, and 75.4% ± 3.9%, respectively. The five-year LRC and CSS for patients treated with RT alone and with CRT were 75.5% ± 6.0% vs. 86.8% ± 4.1% (p = 0.155) and 88.5% ± 4.5% vs. 94.9% ± 2.9% (p = 0.161), respectively. In the multivariate analysis, no clinical or therapeutic factors were found to significantly influence the LRC and CSS, while the addition of chemotherapy was of borderline significance (p = 0.065 and p = 0.107, respectively). Conclusions: In the management of node negative T1–T2 anal cancer, LRC and CSS tend to be superior in patients treated by combined CRT, even though the difference was not significant. Randomized studies are warranted to assess definitively the role of combined treatment in early-stage anal carcinoma.

  8. Concomitant release of ventral tegmental acetylcholine and accumbal dopamine by ghrelin in rats.

    Directory of Open Access Journals (Sweden)

    Elisabet Jerlhag

    Full Text Available Ghrelin, an orexigenic peptide, regulates energy balance specifically via hypothalamic circuits. Growing evidence suggest that ghrelin increases the incentive value of motivated behaviours via activation of the cholinergic-dopaminergic reward link. It encompasses the cholinergic afferent projection from the laterodorsal tegmental area (LDTg to the dopaminergic cells of the ventral tegmental area (VTA and the mesolimbic dopamine system projecting from the VTA to nucleus accumbens (N.Acc.. Ghrelin receptors (GHS-R1A are expressed in these reward nodes and ghrelin administration into the LDTg increases accumbal dopamine, an effect involving nicotinic acetylcholine receptors in the VTA. The present series of experiments were undertaken directly to test this hypothesis. Here we show that ghrelin, administered peripherally or locally into the LDTg concomitantly increases ventral tegmental acetylcholine as well as accumbal dopamine release. A GHS-R1A antagonist blocks this synchronous neurotransmitter release induced by peripheral ghrelin. In addition, local perfusion of the unselective nicotinic antagonist mecamylamine into the VTA blocks the ability of ghrelin (administered into the LDTg to increase N.Acc.-dopamine, but not VTA-acetylcholine. Collectively our data indicate that ghrelin activates the LDTg causing a release of acetylcholine in the VTA, which in turn activates local nicotinic acetylcholine receptors causing a release of accumbal dopamine. Given that a dysfunction in the cholinergic-dopaminergic reward system is involved in addictive behaviours, including compulsive overeating and alcohol use disorder, and that hyperghrelinemia is associated with such addictive behaviours, ghrelin-responsive circuits may serve as a novel pharmacological target for treatment of alcohol use disorder as well as binge eating.

  9. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

    Directory of Open Access Journals (Sweden)

    Coyle Catherine

    2010-12-01

    Full Text Available Abstract Background Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. Methods A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Results Median age was 55 years (range 34-76 years and 28 (68% patients were male. 35/41 patients (85% received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78% had a clinical response. Concomitant chemotherapy was given to 30/41 (73%. All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15% patients had gastrostomy tubes placed before treatment, and 22 (54% required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85% patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months. Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8% patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Conclusion Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.

  10. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

    International Nuclear Information System (INIS)

    Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Median age was 55 years (range 34-76 years) and 28 (68%) patients were male. 35/41 patients (85%) received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78%) had a clinical response. Concomitant chemotherapy was given to 30/41 (73%). All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15%) patients had gastrostomy tubes placed before treatment, and 22 (54%) required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85%) patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months). Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8%) patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer

  11. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  12. Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Kim Chang Seong

    2011-10-01

    Full Text Available Abstract Background Diabetes mellitus and renal dysfunction are prognostic factors after acute myocardial infarction (AMI. However, few studies have assessed the effects of renal insufficiency in association with diabetes in the context of AMI. Here, we investigated the clinical outcomes according to the concomitance of renal dysfunction and diabetes mellitus in patients with AMI. Methods From November 2005 to August 2008, 9905 patients (63 ± 13 years; 70% men with AMI were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR and were categorized into 4 groups: Group I (n = 5700 had neither diabetes nor renal insufficiency (glomerular filtration rate [GFR] ≥ 60 ml/min/1.73 m2, Group II (n = 1730 had diabetes but no renal insufficiency, Group III (n = 1431 had no diabetes but renal insufficiency, and Group IV (n = 1044 had both diabetes and renal insufficiency. The primary endpoints were major adverse cardiac events (MACE, including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after 1-year clinical follow-up. Results Primary endpoints occurred in 1804 (18.2% patients. There were significant differences in composite MACE among the 4 groups (Group I, 12.5%; Group II, 15.7%; Group III, 30.5%; Group IV, 36.5%; p p = 0.001; and HR, 2.42; 95% CI, 1.62-3.62; p Conclusions Renal insufficiency, especially in association with diabetes, is associated with the occurrence of composite MACE and indicates poor prognosis in patients with AMI. Categorization of patients with diabetes and/or renal insufficiency provides valuable information for early-risk stratification of AMI patients.

  13. Glutathione S-Transferase Gene Polymorphisms and Treatment Outcome in Cervical Cancer Patients under Concomitant Chemoradiation.

    Directory of Open Access Journals (Sweden)

    Mohammad Abbas

    Full Text Available Cisplatin based concomitant chemoradiation (CRT is the standard treatment for locally advanced cervical cancer (CC. Glutathione S-transferase (GST, a phase II antioxidant enzyme is induced by oxidative stress generated by drugs and reactive oxidants. The present study was undertaken to evaluate the association of GSTM1, T1 and P1 polymorphisms with the outcome of CRT treatment in CC patients.A total of 227 cervical cancer patients with stages IIB-IIIB treated with the same chemoradiotherapy regimen were enrolled and genotyped for GSTM1, T1 and P1 gene polymorphisms by multiplex polymerase chain reaction (mPCR and PCR-restriction fragment length polymorphism (PCR-RFLP. Overall survival was evaluated using Kaplan-Meier survival function and Cox proportional hazards model. All data were analyzed using SPSS (version 21.0.Stratified analysis showed that GSTM1 null (M1- genotype was associated with a significantly better survival among patients with stage IIB cervical cancer (log-rank P = 0.004 than cases with stage IIIA/IIIB. Death and recurrence were significantly higher in patients with GSTM1 present genotype (M1+ (P = 0.037 and P = 0.003 respectively and those with M1- showed reduced hazard of death with an adjusted hazard ratio 'HR' of 0.47 (95% CI, 0.269-0.802, P = 0.006. Women with M1- genotype as well as in combination with GSTT1 null (T1-, GSTP1 (AG+GG and GSTT1 null/GSTP1 (AG+GG showed better survival and also reduced risk of death (HR = 0.31, P = 0.016; HR = 0.45, P = 0.013; HR = 0.31, P = 0.02 respectively.To the best of our knowledge, this is the first study to correlate the association of GSTM1, T1 and P1 gene polymorphisms with treatment outcome of CRT treated CC patients. Our results suggested that individuals with GSTM1 null genotype and in combination with GSTT1 null and GSTP1 (AG+GG had a survival advantage. Such genetic studies may provide prognostic information in CRT treated CC patients.

  14. 多西紫杉醇联合卡培他滨治疗蒽环类耐药的转移性乳腺癌%Docetaxel and capecitabine combination chemotherapy for patients with anthracycline-resistant metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    李淑芬; 汪旭; 王忱; 何丽宏; 史业辉; 郝春芳; 董国雷; 佟仲生

    2008-01-01

    目的 观察多西紫杉醇联合卡培他滨(DC方案)治疗蒽环类耐药的晚期乳腺癌的疗效和安全性.方法 选择32例葸环类耐药的转移性乳腺癌患者,给予DC方案化疗.根据WHO制定的实体瘤客观疗效评价标准和抗癌药物毒性分级(0~Ⅳ)标准评价疗效和不良反应.结果 32例患者共完成126个周期化疗,每例患者的化疗周期数为2~12个,中位化疗周期数4个.完全缓解(CR)1例,部分缓解(PR)14例,稳定(SD)11例,进展(PD)6例,总有效率为46.9%.14例肺转移患者中8例有效,13例肝转移患者中6例有效,7例皮肤软组织转移患者中3例有效,5例淋巴结转移患者中3例有效.32例患者的中位肿瘤进展时间(TTP)为5.6个月.1年生存率为56.3%.主要不良反应为骨髓抑制、手足综合征、恶心、呕吐、腹泻、口腔黏膜炎等,84.4%的患者出现中性粒细胞下降,2例达Ⅳ度骨髓抑制.结论 DC方案治疗转移性乳腺癌的有效率高,不良反应可以耐受,是治疗对蒽环类耐药转移性乳腺癌的有效方案.%Objective To evaluate the efficacy and safety of docetaxel and capecitabine combination chemotherapy (DC regimen) for patients with anthracycline-resistant metastatic breast cancer. Methods Thirty-two patients with anthracycline-resistant metastatic breast cancer were treated with a decetaxel and capecitabine combination regimen. All patients received oral administration of eapecitabine at a dose of 1250 mg/m2 twice daily,within 30 min after meal on D1 to D14,and intravenous infusion of decetaxel at a dose of 75 mg/m2 on D1. The regimen was repeated every 3 weeks. Results A total of 126 cycles of DC regimen were administered in the 32 cases,with a median of 4 cycles. The overall response rate was 46.9%. Among the 32 patients, there were complete response in 1, partial response in 14, stable disease in 11 and progressive disease in 6 cases. The median time to progression (TIP) was 5.6 months. The one-year survival

  15. Clinical research on capecitabine combined with cisplatin in the treatment of advanced breast cancer%卡培他滨联合顺铂治疗晚期乳腺癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    陆婉玲; 党亚正; 王志刚

    2014-01-01

    目的 探讨卡培他滨联合顺铂治疗蒽环类及紫杉类耐药的晚期乳腺癌的临床效果.方法 选取解放军第三二三医院肿瘤中心的19例蒽环类及紫杉类耐药的晚期乳腺癌患者,给予卡培他滨联合顺铂治疗,21 d为1个周期,所有患者均治疗2个周期以上,观察临床疗效及不良反应.结果 19例患者中完全缓解1例,部分缓解9例,稳定6例,进展3例,总有效率为52.6%.中位无疾病进展生存期6.0个月(95%CI:4.4 ~7.6个月),中位生存期15.0个月(95% CI:13.0 ~ 16.9个月).主要的毒性反应有骨髓抑制、乏力、胃肠道反应及手足综合征等,为可逆性,无治疗相关死亡.结论 卡培他滨联合顺铂疗效较好,毒性反应可耐受,可作为蒽环类及紫杉类耐药的晚期乳腺癌患者的治疗选择.%Objective To evaluate clinical researches on capecitabine combined with cisplatin in the treatment of anthracycline and taxane resistant advanced breast cancer patients.Methods Nineteen cases of anthracycline and taxane resistant advanced breast cancer of 323 Hospital of Chinese People's Liberation Army were selected.They were given capecitabine combined with cisplatin.21 days were as a cycle of chemotherapy and all patients received at least 2 cycles of chemotherapy.The clinical effect and adverse reaction were observed.Results There were complete remission in 1 case,partial remission in 9 cases,stable disease in 6 cases and progress disease in 3 cases;the total effective rate was 52.6% (10/19).The median progression-free survival was 6 months (95% CI:4.4-7.6 months) ; median overall survival was 15.0 months(95% CI:13.0-16.9 months).The major toxicity was myelosuppression,fatigue,gastrointestinal reaction and hand-foot syndrome.There was no treatment related death.Conclusion Combination therapy of capecitabine and cisplatin is an effective and well tolerated regimen for anthracycline-and taxane-resistant advanced breast cancer patients.

  16. 卡培他滨单药治疗老年晚期乳腺癌的临床观察%Clinical Observation of Capecitabine Monotherapy in Treatment of Elder Patients with Advanced Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    方立萍; 蒋葵; 吴紫权; 张阳

    2012-01-01

    目的 观察卡培他滨单药治疗老年晚期乳腺癌的临床疗效和毒性反应.方法 36例Ⅳ期老年乳腺癌患者均经病理组织学或细胞学检查确诊.治疗剂量卡培他滨:2500 mg/m2,分早晚2次餐后半小时口服,第1 ~ 14天,每3~4周重复,2周期后评价疗效.结果 36例患者均可评价,其中获完全缓解(CR)0例,部分缓解(PR) 10例,稳定(SD) 14例,进展(PD)12例,总有效率27.8% (10/36).临床获益率(CR+ PR+ SD) 66.7% (24/36),中位疾病进展时间(TTP)7.1个月.主要的毒副反应为手足综合症、腹泻、口腔炎,均可耐受,无化疗相关死亡.结论 卡培他滨单药治疗老年晚期乳腺癌疗效确切,可明显改善患者生存质量,延长生存时间,副反应轻,耐受性良好并适合门诊治疗,是一种安全有效的姑息治疗方案.%Objective To evaluate the clinical efficacy and toxicity of capecitabine monotherapy in treatment of elder patients with advanced breast cancer. Methods Thirty six patients with advanced breast cancer confirmed by pathology or cytology were enrolled into the study. The patients received capecitabine 1250 mg/m2 twice daily,within 30 min after meal dl -14,every 3 -4 weeks and were evaluated efficacy after 2 cycles. Results None complete remission( CR) case was observed,PR was in 10 cases, 14 cases had stable disease( SD) and 12 cases got progressive disease( PD). The clinical benefit response rate( CR + PR + SD) was 66.7% (24/36). The median time to progression(TTP) was 7. 1 months. The main side effects were hand-foot syndrome , diarrhea and stomatitis which were all tolerable. Conclusion The regimen of capecitabine is effect, safe and well-tolerable in the treatment of elder patients with advanced breast cancer. It can significantly improve the quality of life in patients with advanced breast cancer, and prolong the survival time. The side effects are light and were well tolerated. It is suitable for outpatient treatment. The method is a safe

  17. 卡培他滨单药治疗晚期乳腺癌的临床研究%Clinical study of capecitabine monotherapy in the treatment of advanced metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    曲范杰; 张咏梅; 鹿嫣一

    2011-01-01

    目的 观察和评价卡培他滨单药治疗晚期复发转移性乳腺癌的临床疗效和毒性反应.方法 21例晚期复发转移性乳腺癌患者均经病理组织学和(或)细胞学检查确诊.给予单药卡培他滨2000 mg/(m2·d),分2次口服,连服2周,3周为1个周期.至少2个周期后评价疗效.21 d为1个周期,至少治疗2个周期.结果 21例患者均可评价,CR 1例,PR 6例,SD 8例,PD 6例,患者的近期有效率为33.4%、疾病控制率(CR +PR +SD)为71.4%(15/21),TTP、中位生存期及1年、2年生存率分别为5.1个月、13.2个月和50.1%、33.2%.常见不良反应为手足综合征(66.7%)、皮肤色素沉着(52.5%)、恶心、呕吐(28.6%)和腹泻15%,但均可以耐受.结论 单药卡培他滨对复发转移性乳腺癌有较好的临床疗效,可改善患者的生存质量,延长生存时间,毒性反应比较轻,老年患者亦可以耐受.%Objective Observing efficacy,toxicity and side effects of capecitabine monotherapy in the treatment of advanced metastatic breast cancer. Methods 21 cases of advanced metastatic breast cancer patients were treated with capecitabine 2000 mg/m orally twice a day for 2 weeks every 3 weeks. The efficacy was estimated after 2 cycles. Results Complete remisson (CR) was observed in 1 case and PR in 6 cases, SD in 8 cases, the response rate were 33. 4% , The control rate (CR + PR+SD) was71.4%(15/ 21) ,time to progress(TTP) , median survial time (MST) and 1-year survial were 5. 1 months, 13. 2months, and 50. 1% respectively, The toxicity and side effects were hand-foot syndrome(66. 7% ) ,skin pigmentation (52. 5% ), nausea and vomiting ( 28. 6% ) , and diarrhea ( 15% ) but could be tolerable. Conclusion capecitabine monotherapy in the treatment of metastatic breast cancer is effective, safe and well tolerable. It may relieve the symptoms, improve quality of life and prolong the survial time. Patients were willing to receive it easily.

  18. Observation of Treating Advanced Breast Cancer with Ginsenoside Rg3 Combining with Capecitabine%参一胶囊联合卡培他滨治疗晚期乳腺癌临床观察

    Institute of Scientific and Technical Information of China (English)

    寇小格; 梁东良; 李小瑞

    2011-01-01

    目的 评价参一胶囊联合卡培他滨治疗晚期乳腺癌的疗效、机制及对化疗不良反应和生活质量的影响.方法 采用前瞻性随机对照研究,把56例晚期乳腺癌患者分为治疗组与对照组.治疗组28例,给予参一胶囊联合卡培他滨治疗;对照组28例单纯给予卡培他滨治疗.结果 治疗组和对照组有效率分别为35.7%、25%.1年生存率分别为68%、50%,差异均无统计学意义.治疗组白细胞减少率和疲劳发生率分别为17.9%、7.1%,对照组分别为42.9%、32.1%、两组白细胞减少率、疲劳发生率比较差异均有统计学意义.治疗组与对照组相比能显著降低VEGF的值,提高了生活质量.结论 参一胶囊联合卡培他滨治疗晚期乳腺癌有提高患者生存期的趋势,并可以减少化疗引起的疲劳、白细胞降低等不良反应,提高患者的生活质量等,其机制可能与参一胶囊有抗血管生成作用等有关.%Objective To explore the effect of ginsenoside Rg3 (Shenyi Capsule) combining with Capecitabine on antitumor efficacy, mechanism, toxicity and quality of life in patients with advanced breast cancer. Methods The prospective, randomized, controlled method was adopted. 56 patients with advanced breast cancer were randomly assigned to trial group (28 cases)and contral group(28 cases), the trial group was administered with ginsenoside Rg3 combining with Capecitabine and the contral group was administered with Capecitabine alone. Results The response rate in trial group and control group was 35.7% and 25%, respectively. The 1-year survival rate was 68% and 50%, respectively. There was no significant difference between the 2 groups (P>0. 05). Results: In trial group, the major hematologic toxicities was neutropenia 17. 9%, with a 7. 1 % fatigue, while the rates of neutropenia and fatigue were 42.9% and 32. 1 % in control group, respectively. There was significant difference between the two groups in this case

  19. Pharmacodynamic interactions between MDMA and concomitants in MDMA tablets on extracellular dopamine and serotonin in the rat brain.

    OpenAIRE

    Ikeda, Rie; Igari, Yoshiko; Fuchigami, Yuki; Wada, Mitsuhiro; Kuroda, Naotaka; Nakashima,Kenichiro

    2011-01-01

    3,4-methylenedioxymethamphetamine (MDMA) is a psychoactive stimulant abused by young people as the recreational drug ecstasy. Other compounds, either deliberately added or present as byproducts, are often found in MDMA tablets and can unexpectedly interact with each other. The aim of this study was to evaluate the pharmacodynamic effects of interactions caused by concomitants in MDMA tablets on extracellular dopamine and serotonin (5-HT) by microdialysis in the striatum of ethylcarbamate-anes...

  20. Clinical efficacy of gliclazide with modified release after myocardial infarction in patients with concomitant type 2 diabetes

    OpenAIRE

    Mykhailovska, N. S.

    2014-01-01

    Introduction. At present, the most clinically efficiency on reducing the risk of cardiovascular complications in patients with type 2 diabetes showed by intense step by step hypoglycemia strategy of therapy with sulfonylureas - gliclazide modified release. However, there is an insufficient number of works that would specifically study the effectiveness of this drug in patients with Q- myocardial infarction with concomitant type 2diabetes mellitus in the acute stage of the disease after 6 and ...

  1. Gastric ulcer patients are more susceptible to developing gastric cancer compared with concomitant gastric and duodenal ulcer patients

    OpenAIRE

    Hong, Jun-Bo; Zuo, Wei; Wang, An-Jiang; Xu, Shan; TU, LU-XIA; Chen, You-Xiang; ZHU, XUAN; LU, NONG-HUA

    2014-01-01

    Intestinal metaplasia (IM) and dysplasia are precancerous lesions of gastric cancer (GC); however, the prevalence of IM and dysplasia in patients exhibiting single gastric ulcer (GU) and concomitant gastric and duodenal ulcer (CGDU) varies. In the present study consecutive patients who had undergone esophagogastroduodenal endoscopy were retrospectively screened, and those presenting with GU or CGDU were further evaluated for IM and dysplasia. Patients diagnosed with GC or lymphoma and patient...

  2. Comparison of concomitant boost radiotherapy against concurrent chemoradiation in locally advanced oropharyngeal cancers: A phase III randomised trial

    International Nuclear Information System (INIS)

    Purpose: To test the toxicity and efficacy of concomitant boost radiotherapy alone against concurrent chemoradiation (conventional fractionation) in locally advanced oropharyngeal cancer in our patient population. Methods and materials: In this open-label, randomised trial, 216 patients with histologically proven Stage III–IVA oropharyngeal cancer were randomly assigned between June 2006 and December 2010 to receive either chemoradiation (CRT) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m2 on days 1, 22 and 43) or accelerated radiotherapy with concomitant boost (CBRT) to a dose of 67.5 Gy in 40 fractions over 5 weeks. The compliance, toxicity and quality of life were investigated. Disease-free survival (DFS) and overall survival (OS) curves were estimated with the Kaplan–Meier method and compared using log rank test. Results: The compliance to radiotherapy was superior in concomitant boost with lesser treatment interruptions (p = 0.004). Expected acute toxicities were significantly higher in CRT, except for grade 3/4 mucositis which was seen more in CBRT arm (39% and 55% in CRT and CBRT, respectively; p = 0.02). Late toxicities like Grade 3 xerostomia were significantly high in CRT arm than CBRT arm (33% versus 18%; p 2 cm had significantly better DFS with CRT (p = 0.05; HR-1.59, 95%CI-0.93–2.7). Conclusion: In selected patients of locally advanced oropharyngeal cancer, concomitant boost offers a better compliance, toxicity profile and quality of life with similar disease control, than chemoradiation

  3. HDR brachytherapy combined with interstitial hyperthermia in locally advanced cervical cancer patients initially treated with concomitant radiochemotherapy – a phase III study

    International Nuclear Information System (INIS)

    Background and purpose: The aim of this randomised trial was to investigate whether hyperthermia (HT) combined with interstitial brachytherapy (ISBT) has any influence on local control (LC), disease-free survival (DFS), or acute and late side effects in patients with advanced cervical cancer. Materials and methods: After radiochemotherapy, consecutive patients with cervical cancer (FIGO stage II–III) were randomly assigned to two treatment groups, either ISBT alone or ISBT combined with interstitial hyperthermia (ISHT). A total of 205 patients were included in the statistical analysis. Once a week, HT, at a temperature above 42.5 °C, was administered for 45 min before and during the HDR BT. Results: The median follow-up time was 45 months (range 3–72 months). An effect of hyperthermia was not detected for disease-free survival (DFS) (log-rank test: p = 0.178) or for local control (LC) (p = 0.991). According to Cox’s analysis, HT did not significantly influence failure or interactions with potential prognostic factors for LC or DFS. Statistical differences were not observed for the distribution of early and late complications between the HT and non HT groups. Conclusions: ISHT is well-tolerated and does not affect treatment-related early or late complications. Improvements in DFS and LC were not observed following the addition of ISHT to ISBT

  4. Concomitant osteomyelitis and avascular necrosis of the talus treated with talectomy and tibiocalcaneal arthrodesis.

    Science.gov (United States)

    Stapleton, John J; Zgonis, Thomas

    2013-04-01

    The goal with Lisfranc fracture-dislocations is to regain joint congruity and reestablish midfoot stability to avoid debilitating posttraumatic arthrosis and chronic pain in the sensate patient. In the diabetic population, dense peripheral neuropathy and/or vascular disease are equally important and may alter the surgical approach to traumatic tarsometatarsal injuries. The initial diagnosis in the diabetic population may be delayed due to subtle radiographic findings and/or patient unawareness of trauma in the insensate foot. Failure to initiate treatment in the early stages of acute diabetic neuropathic Lisfranc injuries can predispose the patient to midfoot instability, potential ulceration, infection, and Charcot neuroarthropathy. PMID:23465813

  5. Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain.

    Science.gov (United States)

    Younis, Samaira; Maarbjerg, Stine; Reimer, Maren; Wolfram, Frauke; Olesen, Jes; Baron, Ralf; Bendtsen, Lars

    2016-07-01

    The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN patients have questioned this. Our aim was to examine whether TN patients without sensory abnormalities at neurological examination have sensory abnormalities at quantitative sensory testing (QST) and whether there were any QST differences between TN with and without concomitant persistent pain. Thirty-six TN patients were investigated with the standardized QST protocol by the German Research Network on Neuropathic Pain. The investigators were blinded to presence of concomitant persistent pain and symptomatic side. Based on comparison to the German Research Network on Neuropathic Pain controls, z scores were calculated to process frequency analyses and Z-profiles. We found increased mechanical detection threshold on the symptomatic side (47.2% vs 0%, P = 0.008), asymptomatic side (33.3% vs 0%, P = 0.011), and hand (36% vs 0%, P Trigeminal neuralgia patients with concomitant persistent pain tended to have higher mean z score values compared to TN with purely paroxysmal pain indicative of decreased detection thresholds. Trigeminal neuralgia patients with no sensory abnormalities at neurological examination had generalized subclinical hypoesthesia, which was more pronounced on the symptomatic side, and thermal and mechanical hyperalgesia. This could indicate pain-induced hypoesthesia and sensitization induced by central mechanisms. PMID:26894914

  6. Combined-modality treatment in advanced oral squamous cell carcinoma. Primary surgery followed by adjuvant concomitant radiochemotherapy

    International Nuclear Information System (INIS)

    The efficacy of adjuvant radiochemotherapy (RCT) in patients with advanced stage head and neck carcinoma has been proven in prospective randomized trials. However, these trials focused on different head and neck sites. Specific analyses for treatment effects in squamous cell carcinoma of the oral cavity (OSCC) are missing. We evaluated our experiences with adjuvant concomitant RCT in advanced OSCC to compare the results with other treatment schemes using adjuvant RCT. A total of 183 patients with OSCC of UICC stages II-IVb were reviewed retrospectively. All patients were treated with radical surgery followed by adjuvant, conventional fractionated concomitant RCT using carboplatin. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Univariate analysis showed a significant impact of T, N, and UICC stage, histopathologic grading, surgical margins, extracapsular spread (ECS), and lymphangiosis carcinomatosa on overall survival (Table 3). Patients with stage IVa had a higher 5-year overall survival rate (42.8%) than patients with stage IVb (25.0%) (Figure 1). The differences were significant in multivariate analysis (p = 0.033) (Table 4). Adjuvant concomitant RCT is an effective treatment in patients with advanced stage OSCC. However, it remains unclear, which patients should be treated with adjuvant RCT. For patients with stage IVb, adjuvant RCT yields poor results. Prospective randomized trials are needed to confirm which patients should be treated with adjuvant RCT. (orig.)

  7. Combined-modality treatment in advanced oral squamous cell carcinoma. Primary surgery followed by adjuvant concomitant radiochemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kreppel, Matthias; Dreiseidler, Timo; Zoeller, Joachim E.; Scheer, Martin [Koeln Univ. (Germany). Dept. for Oral and Cranio-Maxillo and Facial Plastic Surgery; Center of Integrated Oncology (CIO) Koeln-Bonn, Koeln und Bonn (Germany); Drebber, Uta [Koeln Univ. (Germany). Dept. of Pathology; Center of Integrated Oncology (CIO) Koeln-Bonn, Koeln und Bonn (Germany); Eich, Hans-Theodor; Mueller, Rolf-Peter [Koeln Unvi. (Germany). Dept. of Radiation Oncology; Center of Integrated Oncology (CIO) Koeln-Bonn, Koeln und Bonn (Germany)

    2011-09-15

    The efficacy of adjuvant radiochemotherapy (RCT) in patients with advanced stage head and neck carcinoma has been proven in prospective randomized trials. However, these trials focused on different head and neck sites. Specific analyses for treatment effects in squamous cell carcinoma of the oral cavity (OSCC) are missing. We evaluated our experiences with adjuvant concomitant RCT in advanced OSCC to compare the results with other treatment schemes using adjuvant RCT. A total of 183 patients with OSCC of UICC stages II-IVb were reviewed retrospectively. All patients were treated with radical surgery followed by adjuvant, conventional fractionated concomitant RCT using carboplatin. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Univariate analysis showed a significant impact of T, N, and UICC stage, histopathologic grading, surgical margins, extracapsular spread (ECS), and lymphangiosis carcinomatosa on overall survival (Table 3). Patients with stage IVa had a higher 5-year overall survival rate (42.8%) than patients with stage IVb (25.0%) (Figure 1). The differences were significant in multivariate analysis (p = 0.033) (Table 4). Adjuvant concomitant RCT is an effective treatment in patients with advanced stage OSCC. However, it remains unclear, which patients should be treated with adjuvant RCT. For patients with stage IVb, adjuvant RCT yields poor results. Prospective randomized trials are needed to confirm which patients should be treated with adjuvant RCT. (orig.)

  8. Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach

    Directory of Open Access Journals (Sweden)

    Saba Davit

    2006-06-01

    Full Text Available Abstract Background Coarctation of the aorta in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention. Ideal approach in such patients is uncertain. Anatomic left-sided short aortic bypass from the arcus aorta to descending aorta via median sternotomy allows simultaneuos repair of both complex aortic coarctation and concomitant cardiac operation. Materials Four adult patients were underwent Anatomic left-sided short aortic bypass operation for complex aortic coarctation through median sternotomy using deep hypothermic circulatory arrest. Concomitant cardiac operations were Bentall procedure for annuloaortic ectasia in one patient, coronary artery bypass grafting for three vessel disease in two patient, and patch closure of ventricular septal defect in one patient. Results All patients survived the operation and were alive with patent bypass at a mean follow-up of 36 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Conclusion We conclude that single-stage repair of adult aortic coarctation with concomitant cardiovascular lesions can be performed safely using this newest technique.

  9. Safety analysis of high dose (>6 mg/kg/day) daptomycin in patients with concomitant statin therapy.

    Science.gov (United States)

    Parra-Ruiz, J; Dueñas-Gutiérrez, C; Tomás-Jiménez, C; Linares-Palomino, J P; Garrido-Gomez, J; Hernández-Quero, J

    2012-08-01

    There is a paucity of data regarding efficacy and safety of concomitant therapy of daptomycin and statins, so we reviewed patients that concomitantly received daptomycin and statins to identify any potential increase in toxicity in our cohort. This retrospective study included all patients that received >6 mg/kg/day of daptomycin along with statins and had efficacy and safety data. Patients on high dose (>6 mg/kg/day) daptomycin therapy that did not received statins served as controls. One hundred four patients were included. Median daptomycin dose was 7.8 mg/kg/day (range 6.5-10.8 mg/kg/day), for a mean duration of therapy of 17 days (range 10-51 days). Thirty-six patients received daptomycin and statins and 68 received only daptomycin. Muscular toxicity defined as CPK levels>1000 UI/L (2.5 times upper normal limit, range of determination 200-400 UI/L) was equally distributed between both groups (3/36, 8% vs 7/68, 10%; p=0.746). Despite biochemical toxicity, we did not find clinical toxicity and daptomycin treatment was completed in all cases. We did not find predictors of increased CPK during daptomycin therapy. Based on our data, concomitant administration of daptomycin and statins is safe and is not associated with an increased risk of rhabdomyolysis. PMID:22160888

  10. 多西紫杉醇联合卡培他滨治疗晚期乳腺癌的疗效观察%Clinical effect of advanced breast cancer treated by docetaxel combined with capecitabine

    Institute of Scientific and Technical Information of China (English)

    田新庆; 王文珍; 王小娜

    2012-01-01

    Objective:To observe the curative effect and toxicity of semimonthly docetaxel plus capecitabine in ad-venced breast cancer patients who were drug resistance in using anthracene nucleus drugs. Methods: All 36 patients with advanced breast cancer who had received anthracycline chemotherapy before (5 patients had been treated with paclitaxel) were observed. These patients received docetaxel combined with capectabine for 2 -4 cycles. Three weeks as one cycle. Efficacy was evaluated after 2 cycles. Results: Of these 36 patients, 5 patients got complete remission, 19 patients partial remission,9 pationts stable disease , and 3 patients progression. The overall response rate was 66.7%. The main toxicities were alopecia, neutropenia, and other side effects were mild. There was no any death during treatment. Conclusion: Combintion chemotherapy of semimonthly docetaxel and capecitabine has a good anti - tumor effect and tolerable toxicity on advanced breast cancer patients who were drug resistant in using anthracene nucleus drugs.%目的:观察多西紫杉醇联合卡培他滨方案对蒽环类耐药的晚期乳腺癌患者的临床疗效及毒副作用.方法:36例既往接受过蒽环类(其中5例接受过紫杉醇)等药物化疗的晚期乳腺癌患者,均有临床观察指标,采用多西紫杉醇联合卡培他滨化疗2-4周期,每3周重复一次,行2周期治疗后判定疗效.结果:36例中CR5例,PR 19例,NC 9例,PD 3例,总有效率为66.7%.主要不良反应为白细胞减少、脱发,其它毒副反应均较轻微可耐受,无化疗相关死亡.结论:国产多西紫杉醇联合卡培他滨治疗蒽环类耐药的晚期乳腺癌有较好疗效,不良反应轻,耐受性好,是治疗对蒽环类耐药的晚期乳腺癌较好的方案.

  11. Hormonal therapy might be a better choice asmaintenance treatment thancapecitabine afterresponse toifrst-line capecitabine-based combination chemotherapy forpatients withhormone receptor-positive andHER2-negative, metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    Xue-LianChen; FengDu; Ruo-XiHong; Jia-YuWang; YangLuo; QingLi; YingFan; Bing-HeXu

    2016-01-01

    Background:Both hormonal therapy (HT) and maintenance capecitabine monotherapy (MCT) have been shown to extend time to progression (TTP) in patients with metastatic breast cancer (MBC) after failure of taxanes and anthracycline‑containing regimens. However, no clinical trials have directly compared the effcacy of MCT and HT after response to ifrst‑line capecitabine‑based combination chemotherapy (FCCT) in patients with hormone receptor (HR)‑positive and human epidermal growth factor receptor 2 (HER2)‑negative breast cancer. Methods:We retrospectively analyzed the charts of 138 HR‑positive and HER2‑negative MBC patients who were in non‑progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, in Beijing, China. The median number of ifrst‑line chemotherapy cycles was 6 (range, 4–8); combined agents included taxanes, vinorelbine, or gemcitabine. Of these 138 patients, 79 received MCT, and 59 received HT. Single‑agent capecitabine was administered at a dose of 1250mg/m2 twice daily for 14days, followed by a 7‑day rest period, repeated every 3weeks. Of the 59 patients who received HT, 37 received aromatase inhibitors (AIs), 8 received selective estrogen receptor modulators (SERMs), and 14 received goserelin plus either AIs or SERMs. We then compared the MCT group and HT group in terms of treatment effcacy. Results:With a median follow‑up of 43months, patients in the HT group had a much longer TTP than patients in the MCT group (13 vs. 8months,P=0.011). When TTP was adjusted for age, menopausal status, Karnofsky performance status score, disease‑free survival, site of metastasis, number of metastatic sites, and response status after FCCT, extended TTP was still observed for patients in the HT group (hazard ratio: 0.63; 95% conifdence interval: 0.44–0.93;P=0.020). We also observed a trend of overall survival advantage for patients in the HT group vs

  12. NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu [Massachusetts General Hospital, Boston, Massachusetts (United States); Moughan, Jennifer [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Garofalo, Michael C. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Bendell, Johanna [Sarah Cannon Research Institute, Nashville, Tennessee (United States); Berger, Adam C. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Oldenburg, Nicklas B.E. [North Main Radiation Oncology, Providence, Rhode Island (United States); Anne, Pramila Rani [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Perera, Francisco [London Regional Cancer Program/Western Ontario, London, Ontario (Canada); Lee, R. Jeffrey [Intermountain Medical Center, Salt Lake City, Utah (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Nowlan, Adam [Piedmont Hospital, Atlanta, Georgia (United States); DeNittis, Albert [Main Line Community Clinical Oncology Program, Wynnewood, Pennsylvania (United States); Crane, Christopher [University of Texas-MD Anderson Cancer Center, Houston, Texas (United States)

    2015-09-01

    Purpose: To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. Methods and Materials: Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). Results: Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. Conclusion: The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

  13. Concomitant infestation of Toxocara cati and Ancylostoma tubaeforme in a mongrel cat.

    Science.gov (United States)

    Saravanan, M; Sarma, K; Mondal, D B; Ranjith Kumar, M; Vijayakumar, H

    2016-03-01

    A 3½ years old mongrel female cat was brought with the history of inappetence, seizure and lateral recumbency since 4 days and motion sickness since 2 days. Faecal examination confirmed Toxocara cati and Ancylostoma tubaeforme along with un-hatched live Toxocara cati larvae. Treatment has been initiated with Pyrantel pamoate and along with supportive therapy. PMID:27065627

  14. Results of a modeling workshop concerning economic and environmental trends and concomitant resource management issues in the Mobile Bay area

    Science.gov (United States)

    Hamilton, David B.; Andrews, Austin K.; Auble, Gregor T.; Ellison, Richard A.; Johnson, Richard A.; Roelle, James E.; Staley, Michael J.

    1982-01-01

    During the past decade, the southern regions of the U.S. have experienced rapid change which is expected to continue into the foreseeable future. Growth in population, industry, and resource development has been attributed to a variety of advantages such as an abundant and inexpensive labor force, a mild climate, and the availability of energy, water, land, and other natural resources. While this growth has many benefits for the region, it also creates the potential for increased air, water, and solid waste pollution, and modification of natural habitats. A workshop was convened to consider the Mobile Bay area as a site-specific case of growth and its environmental consequences in the southern region. The objectives of the modeling workshop were to: (1) identify major factors of economic development as they relate to growth in the area over the immediate and longer term; (2) identify major environmental and resource management issues associated with this expected growth; and (3) identify and characterize the complex interrelationships among economic and environmental factors. This report summarizes the activities and results of a modeling workshop concerning economic growth and concomitant resource management issues in the Mobile Bay area. The workshop was organized around construction of a simulation model representing the relationships between a series of actions and indicators identified by participants. The workshop model had five major components. An Industry Submodel generated scenarios of growth in several industrial and transportation sectors. A Human Population/Economy Submodel calculated human population and economic variables in response to employment opportunities. A Land Use/Air Quality Submodel tabulated changes in land use, shoreline use, and air quality. A Water Submodel calculated indicators of water quality and quantity for fresh surface water, ground water, and Mobile Bay based on discharge information provided by the Industry and Human

  15. Daily amifostine given concomitantly to chemoradiation in head and neck cancer. A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Trog, D.; Bank, P.; Wendt, T.G. [Friedrich-Schiller Univ., Jena (Germany). Dept. of Radiation Oncology; Koscielny, S.; Beleites, E. [Friedrich-Schiller Univ., Jena (Germany). Dept. of Ear Nose Throat Diseases

    1999-09-01

    Background: In patients with loco-regionally advanced head and neck cancer conventionally fractionated radiotherapy alone results in poor loco-regional control and survival rates. Treatment intensification by simultaneous administration of cytotoxic drugs produces higher acute morbidity. Therefore chemical radioprotection of normal tissues may be of clinical benefit. Patients and Methods: In a pilot study patients with advanced nonresectable head neck cancer treated with conventionally fractionated radical radiotherapy (60 to 66 Gy total doses) and concomitantly given 5-fluorouracil as protracted venous infusion, 250 mg/sqm/24 h over the entire treatment period were given amifostine 300 mg absolutely before each fraction. Acute treatment related mobidity was scored according to CTC classification and loco-regional control and survival rates were estimated. Comparison was made with a historical control group of identical chemoradiation but without amifostine application. Results: Chemoradiation induced oral mucositis was delayed and showed significant lower degrees at all 10 Gy increments (p<0.05) except 60 Gy and over (p>0.05). No significant toxicity was recorded with respect to blood pressure, serum calcium, potassium, hematologic parameters, emesis, nausea or body weight loss. Progression free survival and overall survival probability at 2 years were not statistically different in both cohorts. Conclusion: Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed. (orig.) [German] Hintergrund: Bei Patienten mit lokoregionaer fortgeschrittenen Karzinomen im Kopf-Hals-Bereich fuehrt die alleinige konventionell fraktionierte Radiotherapie zu unuenstigen lokoregionaeren Tumorkontrollraten und Ueberlebensraten. Die Therapieintensivierung durch simultane Radiochemotherapie fuehrt zu gesteigerter Akutmorbiditaet. Die chemische

  16. Impact of Diabetes Mellitus on Peripheral Vascular Disease Concomitant with Coronary

    Directory of Open Access Journals (Sweden)

    Kyomars Abbasi

    2009-03-01

    .02%, femoral (0.18% vs. 0.09%, renal (0.62% vs. 0.25%, and tibialis (0.16% vs. 0.06% arteries had a higher incidence of stenosis than those in the non-diabetics. Conclusion: We conclude that in diabetic patients with concomitant CAD, special attention must be directed towards the diagnosis of PVD using physical examination, Doppler sonography; and where needed, CT-angiography or invasive angiography. Also, in risk assessment, the presence of PVD should be strongly considered for CAD patients.

  17. Concomitant Cushing's Disease and Marked Hyperprolactinemia: Response to a Dopamine Receptor Agonist.

    Science.gov (United States)

    Shiraishi, Jun; Koyama, Hidenori; Shirakawa, Manabu; Ishikura, Reiichi; Okazaki, Hirokazu; Kurajoh, Masafumi; Shoji, Takuhito; Moriwaki, Yuji; Yamamoto, Tetsuya; Namba, Mitsuyoshi

    2016-01-01

    A 38-year-old woman was admitted to our hospital because of amenorrhea, multiple bone fractures, and a Cushingoid appearance. Endocrinological investigations revealed that she had co-existing Cushing's disease and prolactinoma, with a serum level of prolactin (PRL) at 1,480 ng/mL, corticotropin (ACTH) at 81.3 pg/mL, and cortisol at 16.6 μg/dL. Due to the lack of indication for transsphenoidal surgery, cabergoline monotherapy was initiated. A 6-month course of treatment resulted in only subtle amelioration of hypercortisolism, while hyperprolactinemia was dramatically improved. In 5 cases of bihormonal (ACTH/PRL) pituitary macroadenoma reported in the English literature, 2 were initially treated with dopaminergic agonists with substantial effectiveness for both PRL and ACTH. We herein report an extremely rare case of bihormonal macroadenoma in which only PRL was responsive to treatment. PMID:27086808

  18. Concomitant achondroplasia and Chiari II malformation: A double-hit at the cervicomedullary junction

    OpenAIRE

    Awad, Al-Wala; Aleck, Kyrieckos A.; Bhardwaj, Ratan D

    2014-01-01

    We report the first case of a neonate with concurrent Chiari II malformation and achondroplasia. Although rare, both these conditions contribute to several deleterious anatomical changes at the cervicomedullary junction and thus predispose to acute hydrocephalus. Although our patient was initially asymptomatic, hydrocephalus ensued several weeks after birth and required cerebral spinal fluid diversion. We discuss the potential links between the two conditions, the pathophysiology, and the imp...

  19. Accelerated radiotherapy and concomitant high dose chemotherapy in non resectable stage IV locally advanced HNSCC: Results of a GORTEC randomized trial

    International Nuclear Information System (INIS)

    Background: The objective was to evaluate the efficacy of a strong increase of the dose-intensity of concomitant radio-chemotherapy (RT-CT) in patients with far advanced non metastatic HNSCC. Methods: Eligible patients had N3 disease (UICC 1997) and the primary tumor and/or the node(s) had to be strictly unresectable. Patients with palpable N2B-C were also eligible if massive nodal involvement was present. 109 patients were included, with 53 randomized to RT-CT and 56 to accelerated RT. In the RT-CT arm, the RT regimen consisted of 64 Gy in 5 weeks and the CT regimen consisted of synchronous CDDP 100 mg/m2 on days 2, 16, and 30 and 5FU 1000 mg/m2 on days1-5 and 29-33 of the RT course. After RT-CT, two adjuvant cycles of CDDP-5FU were delivered in good responders. A control arm was using a very accelerated RT, delivering 64 Gy in 3 weeks. Results: The most common tumor sites were oropharynx and hypopharynx. Most of the patients had T4 disease (70%) and 100% had a massive nodal involvement (mainly N3 with a mean nodal size >7 cm in both arms). A significant difference was observed in favor of the RT-CT arm (p = 0.005) in terms of cumulative incidence of local regional failure or distant metastases. However, the overall survival and event free survival rates were not significantly different between the two arms (p = 0.70 and 0.16, respectively). The lack of survival benefit in favor of the RT-CT was partly due to an excess of initial early treatment related death in the RT-CT arm. Conclusion: The very intense RT-CT schedule was more efficient on disease control, but was also more toxic than accelerated RT alone, pointing out that there was no clear improvement of the therapeutic index. This study shows the limits of dose-intensification, with regard to concomitant RT-CT.

  20. Initialized Fractional Calculus

    Science.gov (United States)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  1. Efficacy and Safety of the All-Oral Schedule of Metronomic Vinorelbine and Capecitabine in Locally Advanced or Metastatic Breast Cancer Patients: The Phase I-II VICTOR-1 Study

    Directory of Open Access Journals (Sweden)

    M. E. Cazzaniga

    2014-01-01

    Full Text Available Background. Vinorelbine (VRB and capecitabine (CAPE are demonstrated to be active in pretreated metastatic breast cancer patients. Different studies have demonstrated that the metronomic treatment is active with an acceptable toxicity profile. We designed a Phases I-II study to define the MTD of oral metronomic, VRB, and CAPE. Patients and Methods. Phase I: fixed dose of CAPE was 500 mg thrice a day, continuously. Level I of VRB was 20 mg/tot thrice a week for 3 weeks (1 cycle. Subsequent levels were 30 mg/tot and 40 mg/tot (Level III, respectively, if no Grades 3-4 toxicity were observed in the previous level. Phase II: further 32 patients received the MTD of VRB plus CAPE for a total of 187 cycles to confirm toxicity profile. Results. 12 patients were enrolled in Phase I and 22 in Phase II. Phase I: the MTD of VRB was 40 mg. Phase II: 187 cycles were delivered, observing 5.9% of Grades 3-4 toxicity. 31 patients are evaluable for efficacy, obtaining a clinical benefit rate of 58.1%. Conclusion. MTD of VRB with fixed dose of CAPE was 40 mg thrice a week and was the recommended dose for the ongoing Phase II multicenter study.

  2. 含卡培他滨方案治疗复发转移性乳腺癌的临床观察%The effect of Capecitabine containing regimens on 70 cases fo recurrent metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    肖华伍; 欧阳取长

    2012-01-01

    Objective To observe the efficacy and security of capecitabine - contained regimens for patients with recurrent metastatic breast cancer after docetaxel and anthracycline treatment. Methods A total of 70 cases were recruited. Thirty - six patients received NX regimen (NVB 25mg/m2 on day 1 and day 8, capecitabine 800 -1000 mg · m-2· d-1, d1 -14,repeated every 3 weeks. ,in the GX(34) group capecitabine 800 - 1000 mg · m-2 · d-1, d1 -14, gemcitabine lg/m2 ,on day 1 and day 8 . The treatment was repealed every 3 weeks, two cycles at least The efficacy was evaluated every 2 cycles. Results In the NX group, CR was achieved in 1 cases(2.8%), PR in 20 cases( 55. 6% ) , SDinll cases(30.6%), and PD in 4 cases(11. 1% ). The response rate in the NX group was 58. 3% , in the CX group CR was achieved in 1 case(2.9% ) , PR in 19cases(55. 9% ), SD in 12 cases(35.3% ), and PD 2 case(5.9% ) . The response rate in the GX group was 58. 8%. The median time to progress was 13. 5 months, in the NX group and 13. 8 months in the GX group. The common toxicities included myelosuppression, gastrointestinal reactions and, hand - foot syndrome. Conclusions Capecitabine - contained regimens can achieve good results for recurrent metastatic breast cancer after docetaxel and anthracycline treatment, with tolerable side effects.%目的 观察含卡培他滨方案对蒽环类和(或)紫杉类药物治疗后复发转移性乳腺癌的疗效和不良反应.方法 70例蒽环类和(或)紫杉类药物治疗后复发转移性乳腺癌患者分为两组,卡培他滨联合长春瑞滨(NX组,36例),卡堵他滨800~1000mg/m2,分早晚两次服用,第1~14天,长春瑞滨25mg/m2,第1天和第8天,静脉滴注,3周为1个周期.卡培他滨联合吉西他滨( GX组,34例),卡培他滨800 ~ 1000mg/m2,分早晚两次服用,第1 ~14天,吉西他滨1g/m2,静脉滴注,第1天和第8天,3周为1个周期.每两个周期评价疗效,均至少治疗2个周期以上.结果 NX组患者中,完全缓1例(2.8

  3. Clinical observation of capecitabine maintenance treatment for recurrent triple -negativebreast cancer patients%复发转移三阴性乳腺癌卡培他滨维持治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    吴静娜; 李亮; 黄喜文; 王秋明

    2016-01-01

    Objective To evaluate the efficacy and safety of capecitabine maintenance chemotherapy for recurrent triple -negative breast cancer patients without progress post -chemotherapy of first line.Methods A total of 93 recurrent metastatic breast cancer pa-tients,who were negative for ER,PR and HER2,had been evaluated as CR/PR/SD after first -line chemotherapy,were randomly divid-ed into capecitabine maintenance treating group and control group.The treating group(47 cases)took capecitabine orally,and stopped treatment when disease progressing or being intolerant to adverse reaction.The control group(46 cases)were given follow -up regular-ly.The efficacy,progression free survival(PFS),and adverse reaction were compared.Results Themedian PFS of treating group was 8 months(3 ~18 months),higher than that of control group which was 4.5 months(2.5 ~12 months),and the difference of survival was statistically significant(χ2 =27.74,P <0.01).The ORRand DCR of treating group were 55.32% and 87.23% respectively,obviously higher than those of control group.The main adverse reactions were myelosuppression,gastrointestinal reaction,liver function lesion and hand -foot syndrome,which were all tolerable.Conclusions Maintenance chemotherapy with capecitabine can achieve fine efficacy for recurrent triple -negative breast cancer patients without progression post -chemotherapy,and can prolong obviously the progression free survival.The adverse reactions were light and tolerable.%目的:评价应用卡培他滨对一线化疗后未进展的复发转移三阴性乳腺癌进行维持治疗的疗效及安全性。方法将该院93例接受一线化疗有效的复发转移的雌激素受体(ER)、孕激素受体(PR)及人类表皮生长因子受体2(HER2)全阴性的乳腺癌按随机数字表法分为卡培他滨维持观察组和对照组,观察组47例口服卡培他滨,疾病进展或者不良反应不能耐受则停止治疗;对照组46例予以定期随访观察。比

  4. Concomitant loss of proapoptotic BH3-only Bcl-2 antagonists Bik and Bim arrests spermatogenesis

    OpenAIRE

    Coultas, Leigh; Bouillet, Philippe; Loveland, Kate L.; Meachem, Sarah; Perlman, Harris; Adams, Jerry M.; Strasser, Andreas

    2005-01-01

    The BH3-only proteins of the Bcl-2 family initiate apoptosis through the activation of Bax-like relatives. Loss of individual BH3-only proteins can lead either to no phenotype, as in mice lacking Bik, or to marked cell excess, as in the hematopoietic compartment of animals lacking Bim. To investigate whether functional redundancy with Bim might obscure a significant role for Bik, we generated mice lacking both genes. The hematopoietic compartments of bik−/−bim−/− and bim−/− mice were indistin...

  5. Memory reconsolidation allows the consolidation of a concomitant weak learning through a synaptic tagging and capture mechanism.

    Science.gov (United States)

    Cassini, Lindsey F; Sierra, Rodrigo O; Haubrich, Josué; Crestani, Ana P; Santana, Fabiana; de Oliveira Alvares, Lucas; Quillfeldt, Jorge A

    2013-10-01

    Motivated by the synaptic tagging and capture (STC) hypothesis, it was recently shown that a weak learning, only able to produce short-term memory (STM), can succeed in establishing long-term memory (LTM) with a concomitant, stronger experience. This is consistent with the capture, by the first-tagged event, of the so-called plasticity-related proteins (PRPs) provided by the second one. Here, we describe how a concomitant session of reactivation/reconsolidation of a stronger, contextual fear conditioning (CFC) memory, allowed LTM to result from a weak spatial object recognition (wSOR) training. Consistent with an STC process, the effect was observed only during a critical time window and was dependent on the CFC reconsolidation-related protein synthesis. Retrieval by itself (without reconsolidation) did not have the same promoting effect. We also found that the inactivation of the NMDA receptor by AP5 prevented wSOR training to receive this support of CFC reconsolidation (supposedly through the production of PRPs), which may be the equivalent of blocking the setting of a learning tag in the dorsal CA1 region for that task. Furthermore, either a Water Maze reconsolidation, or a CFC extinction session, allowed the formation of wSOR-LTM. These results suggest for the first time that a reconsolidation session can promote the consolidation of a concomitant weak learning through a probable STC mechanism. These findings allow new insights concerning the influence of reconsolidation in the acquisition of memories of otherwise unrelated events during daily life situations. PMID:23733489

  6. Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones.

    Directory of Open Access Journals (Sweden)

    Zhi Chen

    Full Text Available OBJECTIVE: To present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP and concomitant ureteroscopy-assisted pyelolithotomy (U-P for ureteropelvic junction obstruction (UPJO complicated by renal caliceal stones in the same session. METHODS: Between May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm, a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed. RESULTS: The calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm and an average of 3 stones per patient was removed (range, 1 to 6 stones. Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4-7. Stent was removed after 4-8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months. CONCLUSIONS: Mini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.

  7. Non-small Cell Lung Cancer with Concomitant EGFR, KRAS, and ALK Mutation: Clinicopathologic Features of 12 Cases

    Science.gov (United States)

    Lee, Taebum; Lee, Boram; Choi, Yoon-La; Han, Joungho; Ahn, Myung-Ju; Um, Sang-Won

    2016-01-01

    Background: Although epidermal growth factor receptor (EGFR), v-Ki-ras2 Kirsten rat sarcoma viral oncogene (KRAS), and anaplastic lymphoma kinase (ALK) mutations in non-small cell lung cancer (NSCLC) were thought to be mutually exclusive, some tumors harbor concomitant mutations. Discovering a driver mutation on the basis of morphologic features and therapeutic responses with mutation analysis can be used to understand pathogenesis and predict resistance in targeted therapy. Methods: In 6,637 patients with NSCLC, 12 patients who had concomitant mutations were selected and clinicopathologic features were reviewed. Clinical characteristics included sex, age, smoking history, previous treatment, and targeted therapy with response and disease-free survival. Histologic features included dominant patterns, nuclear and cytoplasmic features. Results: All patients were diagnosed with adenocarcinoma and had an EGFR mutation. Six patients had concomitant KRAS mutations and the other six had KRAS mutations. Five of six EGFR-KRAS mutation patients showed papillary and acinar histologic patterns with hobnail cells. Three of six received EGFR tyrosine kinase inhibitor (TKI) and showed partial response for 7–29 months. All six EGFR-ALK mutation patients showed solid or cribriform patterns and three had signet ring cells. Five of six EGFR-ALK mutation patients received EGFR TKI and/or ALK inhibitor and four showed partial response or stable disease, except for one patient who had acquired an EGFR mutation. Conclusions: EGFR and ALK mutations play an important role as driver mutations in double mutated NSCLC, and morphologic analysis can be used to predict treatment response. PMID:27086595

  8. Concomitant stress potentiates the preference for, and consumption of, ethanol induced by chronic pre-exposure to ethanol

    Directory of Open Access Journals (Sweden)

    G. Morais-Silva

    2016-01-01

    Full Text Available Ethanol abuse is linked to several acute and chronic injuries that can lead to health problems. Ethanol addiction is one of the most severe diseases linked to the abuse of this drug. Symptoms of ethanol addiction include compulsive substance intake and withdrawal syndrome. Stress exposure has an important role in addictive behavior for many drugs of abuse (including ethanol, but the consequences of stress and ethanol in the organism when these factors are concomitant results in a complex interaction. We investigated the effects of concomitant, chronic administration of ethanol and stress exposure on the withdrawal and consumption of, as well as the preference for, ethanol in mice. Male Swiss mice (30–35 g, 8-10 per group were exposed to an ethanol liquid diet as the only source of food for 15 days. In the final 5 days, they were exposed to forced swimming stress. Twelve hours after removal of the ethanol liquid diet, animals were evaluated for ethanol withdrawal by measuring anxiety-related behaviors and locomotor activity. Twenty-four hours after evaluation of ethanol withdrawal, they were evaluated for voluntary consumption of ethanol in a “three-bottle choice” paradigm. Mice exposed to chronic consumption of ethanol had decreased locomotor activity during withdrawal. Contrary to our expectations, a concomitant forced swimming stress did not aggravate ethanol withdrawal. Nevertheless, simultaneous ethanol administration and stress exposure increased voluntary consumption of ethanol, mainly solutions containing high concentrations of ethanol. These results showed that stressful situations during ethanol intake may aggravate specific addiction-related behaviors.

  9. Therapeutic efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease

    Directory of Open Access Journals (Sweden)

    Ya-mei RAN

    2015-04-01

    Full Text Available Objective To study the clinical efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease, and its effects on mental health and life-quality of the patients. Methods According to the Rome Ⅲ criteria and Montreal consensus in diagnosis of gastroesophageal reflux disease, 50 patients with concomitant refractory functional dyspepsia and non-erosive reflux disease were recruited. The clinical efficacy of digital music gastric electrical pacing were evaluated using the score of clinical symptoms before treatment and 15 days after treatment, and the mental health and life-quality of patients were assessed using symptom checklist 90. Results Main symptoms, including upper abdominal pain, abdominal fullness, early satiety, belching, hiccup, nausea, heartburn, acid reflux (daytime, nocturnal acid reflux, loss of appetite and sleep, were significantly improved 15 days after treatment compared with those of pre-treatment, and there were statistically significant differences (all P<0.005. The significant response rate/response rate (efficacy rate were 59.0%/100.0%, 59.3%/96.3%, 47.0%/94.1%, 61.3%/96.8 %, 86.7%/100.0%, 80.0%/100.0%, 64.3%/92.9%, 73.7%/89.5%, 64.3%/85.7%, 90.0%/90.0%, 36.7%/93.3% respectively. After treatment for 15 days, the overall response rate of symptom relief was 94.4% in patients and the overall significant response rate was 65.7%. The symptom scores of somatization, obsessive-compulsiveness, depression, and anxiety were significantly improved, and the differences were statistically significant (all P<0.01. Conclusion The clinical efficacy of digital music gastric electrical pacing is significant for refractory functional dyspepsia concomitant with nonerosive reflux disease, and it is expected to be a new option for the treatment of this disease complex. DOI: 10.11855/j.issn.0577-7402.2015.03.08

  10. Incorporating Concomitant Medications into Genome-Wide Analyses for the Study of Complex Disease and Drug Response

    Science.gov (United States)

    Graham, Hillary T.; Rotroff, Daniel M.; Marvel, Skylar W.; Buse, John B.; Havener, Tammy M.; Wilson, Alyson G.; Wagner, Michael J.; Motsinger-Reif, Alison A.; Friedewald, W.T.

    2016-01-01

    Given the high costs of conducting a drug-response trial, researchers are now aiming to use retrospective analyses to conduct genome-wide association studies (GWAS) to identify underlying genetic contributions to drug-response variation. To prevent confounding results from a GWAS to investigate drug response, it is necessary to account for concomitant medications, defined as any medication taken concurrently with the primary medication being investigated. We use data from the Action to Control Cardiovascular Disease (ACCORD) trial in order to implement a novel scoring procedure for incorporating concomitant medication information into a linear regression model in preparation for GWAS. In order to accomplish this, two primary medications were selected: thiazolidinediones and metformin because of the wide-spread use of these medications and large sample sizes available within the ACCORD trial. A third medication, fenofibrate, along with a known confounding medication, statin, were chosen as a proof-of-principle for the scoring procedure. Previous studies have identified SNP rs7412 as being associated with statin response. Here we hypothesize that including the score for statin as a covariate in the GWAS model will correct for confounding of statin and yield a change in association at rs7412. The response of the confounded signal was successfully diminished from p = 3.19 × 10−7 to p = 1.76 × 10−5, by accounting for statin using the scoring procedure presented here. This approach provides the ability for researchers to account for concomitant medications in complex trial designs where monotherapy treatment regimens are not available.

  11. The evaluation of concomitant open reduction and innominate osteotomy in the treatment of congenital dislocation of the hip

    OpenAIRE

    Bilgen, Omer F.; Durak, Kemal; Kejanlioglu, Sinan; Ayan, Mahir; Ozdemir, Recai

    2004-01-01

    Forty eight hips of 34 patients who underwent concomitant open reduction and innominate osteotomy for the treatment of congenital dislocation of the hip were evaluated radiologically and clinically. The study group consisted of 31 (91.1%) girls and 3 (8.9%) boys. The mean age was 24 (17-56) months and the average follow-up period was 4.3 (2.9-7) years. The rate of excellent and good results radiologically and clinically were 83.3% and 87.3% respectively. We established avascular necrosis of 4...

  12. A PILOT TEST OF AN INTEGRATED SELF-CARE INTERVENTION FOR PERSONS WITH HEART FAILURE AND CONCOMITANT DIABETES

    OpenAIRE

    Dunbar, Sandra B.; Butts, Brittany; Reilly, Carolyn M.; Gary, Rebecca A.; Higgins, Melinda K.; Ferranti, Erin P.; Culler, Steven D; Butler, Javed

    2013-01-01

    Studies show 30-47% of persons with heart failure (HF) have concomitant diabetes mellitus (DM). Self-care for persons with both of these chronic conditions is conflicting, complex and often inadequate. This pilot study tested an integrated self-care program for its effects on HF and DM knowledge, self-care efficacy, self-care behaviors and Quality of Life (QOL). Hospitalized HF-DM participants (n=71) were randomized to usual care or intervention using a 1:2 allocation and followed at 30 and 9...

  13. Functional MR Imaging: New tool to predict outcome for cervical carcinoma of uterus treated by concomitant radio chemotherapy?

    International Nuclear Information System (INIS)

    The treatment of advanced cervix is concomitant radio chemotherapy. Local prognosis and global survival depend on tumoral volume, locoregional extension and radio sensitivity of the lesion. This one is function of tumoral hypoxia, tumoral interstitial pressure and existence of an anaemia. Dynamic contract enhanced MRI (D.C.E.-MRI) allows to quantify pilot vascular parameters of the first two factors. Combined analysis: tumoral volume, anaemia and vascular parameters before and in the course of treatment allows a strong correlation with the risk of local recurrence and global survival. (authors)

  14. Neoadjuvant bevacizumab and irinotecan versus bevacizumab and temozolomide followed by concomitant chemoradiotherapy in newly diagnosed glioblastoma multiforme

    DEFF Research Database (Denmark)

    Hofland, Kenneth F; Hansen, Steinbjørn; Sorensen, Morten;

    2014-01-01

    BACKGROUND: Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standard therapy in newly diagnosed glioblastoma multiforme (GBM). Bevacizumab combined with irinotecan produces impressive response rates in recurrent GBM. In a randomized phase II study, we investigated the...... efficacy of neoadjuvant bevacizumab combined with irinotecan (Bev-Iri) versus bevacizumab combined with temozolomide (Bev-Tem) before, during and after radiotherapy in newly diagnosed GBM. MATERIAL AND METHODS: After surgery, patients were randomized to Bev-Iri or Bev-Tem for eight weeks, followed by...

  15. IgA-dominant acute poststreptococcal glomerulonephritis with concomitant rheumatic fever successfully treated with steroids: a case report.

    Science.gov (United States)

    Rus, Rina R; Toplak, Nataša; Vizjak, Alenka; Mraz, Jerica; Ferluga, Dušan

    2015-12-01

    There are only a few reports of the co-occurrence of acute poststreptococcal glomerulonephritis (APGN) and acute rheumatic fever. We report an unusual case of a 3-year-old boy with nephrotic syndrome and acute renal failure with the transitional need for peritoneal dialysis, biopsy-proven atypical IgA-dominant APGN, and concomitant acute rheumatic fever, successfully treated by steroids. Aggressive treatment with pulses of methylprednisolone proved to be successful and we recommend its use in this type of cases. PMID:26718763

  16. Molecular characterization of two different strains of haemotropic mycoplasmas from a sheep flock with fatal haemolytic anaemia, concomitant Anaplasma ovis infection

    OpenAIRE

    Hornok, Sándor; Meli, Marina L; Erdős, András; Hajtós, István; Lutz, Hans; Hofmann-Lehmann, Regina

    2009-01-01

    Molecular characterization of two different strains of haemotropic mycoplasmas from a sheep flock with fatal haemolytic anaemia, concomitant Anaplasma ovis infection HUNGARY (Hornok, Sandor) HUNGARY Received: 2008-08-03 Revised: 2008-10-27 Accepted: 2008-10-29

  17. Forecast evaluation of the impact of the concomitant chemoradiotherapy after conservative breast treatment on the esthetic satisfaction: difference between physician and patient assessment

    International Nuclear Information System (INIS)

    After conservative surgery of mammary glands, the concomitant chemoradiotherapy leads a significant increase of delayed effects ( stage over or equal to 2). The esthetic result is also subjective. The patients satisfaction is superior to the physician's ones after conservative treatment of mammary glands and is not only determined by delayed toxicity. Several methods of evaluation allow to find an esthetic result more harmful after concomitant chemoradiotherapy. (N.C.)

  18. Effects of concomitant fluvoxamine on the plasma concentration of etizolam in Japanese psychiatric patients: wide interindividual variation in the drug interaction.

    Science.gov (United States)

    Suzuki, Yutaro; Kawashima, Yoshiaki; Shioiri, Toshiki; Someya, Toshiyuki

    2004-12-01

    Administration of fluvoxamine with concomitant benzodiazepines is common in clinical situations. This study investigated the effects of the coadministration of fluvoxamine on plasma concentrations of etizolam and evaluated the effects of various fluvoxamine doses on drug interactions with etizolam. Subjects were 18 Japanese outpatients concomitantly treated with fluvoxamine before or after monotherapy with etizolam. Plasma concentrations of etizolam were measured using a column-switching high-performance liquid chromatographic method with ultraviolet detection. In 17 subjects treated concomitantly with fluvoxamine at 25 mg or 50 mg, the ranges of plasma concentrations of etizolam corrected for the dose increased from 2.0-13.3 (mean 6.3 +/- 3.6, n = 17) in monotherapy to 2.7-18.2 (mean 9.6 +/- 5.1, n = 17) ng/mL/mg in concomitant doses. Wide variations were observed in the drug interactions; however, coadministration with fluvoxamine produced significant changes in the plasma concentrations of etizolam (P etizolam-monotherapy and the fluvoxamine-concomitant states. Of the 12 subjects treated concomitantly with fluvoxamine at 25 mg, 2 subjects received fluvoxamine at a dose increased up to 150 mg, and another received fluvoxamine at a dose increased up to 200 mg. They showed an increase in the plasma concentrations of etizolam in a fluvoxamine dose-dependent manner; more particularly, the increased dose of fluvoxamine (150 mg and 200 mg) resulted in about a twofold variation in plasma concentrations of etizolam. PMID:15570188

  19. Cor a 14 is the superior serological marker for hazelnut allergy in children, independent of concomitant peanut allergy

    DEFF Research Database (Denmark)

    Eller, Esben; Mortz, Charlotte G; Bindslev-Jensen, Carsten

    2016-01-01

    BACKGROUND: Hazelnut is the most frequent cause of tree-nut allergy, but up to half of all children with hazelnut allergy additionally suffers from peanut allergy. Our aim was to identify diagnostic values of the most promising serological markers (Cor a 9 and Cor a 14) and to address the influen...... children sensitized to birch pollen protein Bet v 1. This article is protected by copyright. All rights reserved.......BACKGROUND: Hazelnut is the most frequent cause of tree-nut allergy, but up to half of all children with hazelnut allergy additionally suffers from peanut allergy. Our aim was to identify diagnostic values of the most promising serological markers (Cor a 9 and Cor a 14) and to address the influence...... of concomitant peanut allergy and PR10 sensitization. METHOD: We included 155 children suspected off hazelnut allergy and challenged according to guidelines. Concomitant allergy to peanuts was verified or ruled out by challenge. Skin Prick Test, s-IgE and CRD to hazelnut, peanut, PR10 and LPT protein...

  20. Anterior Shoulder Instability with Concomitant Superior Labrum from Anterior to Posterior (SLAP) Lesion Compared to Anterior Instability without SLAP Lesion

    Science.gov (United States)

    Durban, Claire Marie C.; Kim, Je Kyun; Kim, Sae Hoon

    2016-01-01

    Background The aims of this study were to investigate the clinical characteristics of patients with combined anterior instability and superior labrum from anterior to posterior (SLAP) lesions, and to analyze the effect of concomitant SLAP repair on surgical outcomes. Methods We retrospectively reviewed patients who underwent arthroscopic stabilization for anterior shoulder instability between January 2004 and March 2013. A total of 120 patients were available for at least 1-year follow-up. Forty-four patients with reparable concomitant detached SLAP lesions (group I) underwent combined SLAP and anterior stabilization, and 76 patients without SLAP lesions (group II) underwent anterior stabilization alone. Patient characteristics, preoperative and postoperative pain scores, Rowe scores, and shoulder ranges of motion were compared between the 2 groups. Results Patients in group I had higher incidences of high-energy trauma (p = 0.03), worse preoperative pain visual analogue scale (VAS) (p = 0.02), and Rowe scores (p = 0.04). The postoperative pain VAS and Rowe scores improved equally in both groups without significant differences. Limitation in postoperative range of motion was similar between the groups (all p-value > 0.05). Conclusions Anterior instability with SLAP lesion may not be related to frequent episodes of dislocation but rather to a high-energy trauma. SLAP fixation with anterior stabilization procedures did not lead to poor functional outcomes if appropriate surgical techniques were followed. PMID:27247742

  1. Increased Plasma Matrix Metalloproteinase-9 Levels Contribute to Intracerebral Hemorrhage during Thrombolysis after Concomitant Stroke and Influenza Infection

    Directory of Open Access Journals (Sweden)

    Sajjad Muhammad

    2016-08-01

    Full Text Available Background: Thrombolysis is the only approved therapy for acute stroke. However, life-threatening complications such as intracerebral hemorrhage (ICH can develop after intravenous administration of tissue plasminogen activator (tPA. Both infection and thrombolysis during cerebral ischemia disrupt the blood-brain barrier (BBB. tPA can induce matrix metalloproteinase-9 (MMP-9, which is known to be involved in BBB disruption. However, it has still not been investigated whether preexisting influenza virus infection during thrombolysis after acute stroke affects systemic levels of MMP-9 and its inhibitor TIMP-1 and whether increased systemic MMP-9 levels affect ICH. This study aimed to investigate the influence of influenza virus infection on plasma levels of MMP-9 and TIMP-1 after thrombolysis in acute stroke, and to determine whether the infection correlates with intracerebral bleeding. Methods: C57BL/6 mice were infected by administering 1 × 105 plaque-forming units of human influenza (H1N1 virus intranasally. After 3 days of infection the middle cerebral artery was occluded for 45 min and then reperfused. Intravenous tPA (10 mg/kg treatment was started 10 min after stroke onset. Twenty-four hours after stroke onset, mice were deeply anesthetized with ketamine, venous blood was drawn from the caval vein and centrifuged at 2,000 rpm, and the supernatant was collected and frozen at -80°C. Plasma levels of MMP-9 and TIMP-1 were quantified by using ELISA. Results: After stroke, plasma MMP-9 was significantly increased in mice with a concomitant influenza infection that were treated with tPA (9.99 ± 0.62 ng/ml, n = 7 as compared to noninfected control mice that were treated with tPA (4.74 ± 0.48 ng/ml, n = 8. Moreover, plasma levels of TIMP-1, an inhibitor of MMP-9, were also significantly increased in mice treated with tPA after concomitant infection and stroke (42.17 ± 7.02 ng/ml, n = 7 as compared to noninfected control mice that were treated

  2. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome and pulmonary thromboembolism: an overlooked concomitance

    Directory of Open Access Journals (Sweden)

    Vilma Takayasu

    2013-06-01

    Full Text Available The Eosinophilic Granulomatosis with Polyangiitis (formerly Churg- Strauss Syndrome (EGPA is a systemic inflammatory disease characterized by the presence of rhinitis, asthma, peripheral eosinophilia, and vasculitis—the latter being characteristic of the late stage of the disease. After several years from the onset of the disease, small- and medium-sized vessel vasculitis ensues, undertaking various organs and systems. Upper and lower airways, skin, nervous system, gastrointestinal tract, heart, and kidneys are the most commonly involved organs. It is believed that tissue injury is the result of processes mediated by antineutrophil cytoplasmic antibody (ANCA, or toxic mediators released by eosinophils. Although it is classified as ANCA-associated vasculitis, these autoantibodies are present in only 40% of cases. The authors report the case of a patient with EGPA, who had a history of asthma, peripheral and central neuropathy, palpable purpura, gastrointestinal micro perforation, peripheral eosinophilia, and the presence of myeloperoxidase-antineutrophil cytoplasmic antibody. Inflammatory parameters improved after the initiation of treatment, but 1 month after hospital discharge the patient developed symptoms compatible with pulmonary embolism and died. Thrombophilia that occurs in EGPA is due to the interaction between the inflammatory response and eosinophilia with the clotting system resulting in a pro-thrombotic state. Although not yet well-determined, the authors call attention to the possibility of the impact of thromboembolic events on the prognosis of patients with EGPA. In addition to the adequate immunosuppressive treatment, prophylaxis and treatment for thrombosis should never be overlooked.

  3. Salinomycin induces autophagy in colon and breast cancer cells with concomitant generation of reactive oxygen species.

    Directory of Open Access Journals (Sweden)

    Berlinda Verdoodt

    Full Text Available BACKGROUND: Salinomycin is a polyether ionophore antibiotic that has recently been shown to induce cell death in human cancer cells displaying multiple mechanisms of drug resistance. The underlying mechanisms leading to cell death after salinomycin treatment have not been well characterized. We therefore investigated the role of salinomycin in caspase dependent and independent cell death in colon cancer (SW480, SW620, RKO and breast cancer cell lines (MCF-7, T47D, MDA-MB-453. METHODOLOGY/PRINCIPAL FINDINGS: We detected features of apoptosis in all cell lines tested, but the executor caspases 3 and 7 were only strongly activated in RKO and MDA-MB-453 cells. MCF-7 and SW620 cells instead presented features of autophagy such as cytoplasmic vacuolization and LC3 processing. Caspase proficient cell lines activated autophagy at lower salinomycin concentrations and before the onset of caspase activation. Salinomycin also led to the formation of reactive oxygen species (ROS eliciting JNK activation and induction of the transcription factor JUN. Salinomycin mediated cell death could be partially inhibited by the free radical scavenger N-acetyl-cysteine, implicating ROS formation in the mechanism of salinomycin toxicity. CONCLUSIONS: Our data indicate that, in addition to its previously reported induction of caspase dependent apoptosis, the initiation of autophagy is an important and early effect of salinomycin in tumor cells.

  4. Chronic Recurrent Multifocal Osteomyelitis with Concomitant Features of Juvenile Idiopathic Arthritis

    Directory of Open Access Journals (Sweden)

    Elena Tsitsami

    2011-01-01

    Full Text Available We report a case of a 13-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO who developed severe arthritis in four different joints within the first year from the onset of the disease. Her multiple vertebrae lesions showed significant amelioration after a 2-month treatment with prednisolone. In parallel, the initial severe symmetrical arthritis of both knees showing overt synovitis and joint effusion, in the absence of lesions in the metaphyses of the femur or the tibia, responded remarkably well in intra-articular triamcinolone hexacetonide injections. However, upon discontinuation of prednisolone, the patient developed severe arthritis of her right ankle and the proximal interphalangeal joint of her right middle finger. Thus, prednisolone was reinitiated combined with methotrexate, and the patient went into remission, which persists one year after prednisolone tapering. The appearance of arthritis in both knees in the absence of bone lesions and the emergence of severe arthritis of the ankle after remission of spinal bone lesions suggest that CRMO and juvenile idiopathic arthritis may coexist and be causally related.

  5. Neochloris oleoabundans grown on anaerobically digested dairy manure for concomitant nutrient removal and biodiesel feedstock production

    International Nuclear Information System (INIS)

    Microalgae have been investigated as a promising biodiesel feedstock; however, large-scale production is not currently cost-competitive with petroleum diesel, and its environmental impacts have received little attention. Using wastewater to supply nutrients for algal growth obviates synthetic fertilizer use, provides on-site nutrient removal, and reduces greenhouse gas emissions. In this work, anaerobically digested dairy manure was used to grow the oleaginous green alga Neochloris oleoabundans. In batch culture experiments with both synthetic media and anaerobic digester effluent, N. oleoabundans assimilated 90-95% of the initial nitrate and ammonium after 6 d and yielded 10-30% fatty acid methyl esters on a dry weight basis. Cellular lipid content and the N concentration in the growth media were inversely correlated. In addition, the proportion of polyunsaturated fatty acids (i.e. C16:3, C18:2, and C18:3) decreased with N concentration over time while the proportion of C18:1 fatty acid increased. Although N deficiency is likely the primary driver behind lipid accumulation, the influence of culture pH confounded results and requires further study. Other living microorganisms in the digester effluent were not observed to affect algal growth and lipid productivity, though the breakdown of organic nitrogen may have hindered lipid accumulation traditionally achieved through the manipulation of synthetic media. This work highlights the potential for waste-grown mono-algal cultures to produce high quality biodiesel while accomplishing simultaneous wastewater treatment.

  6. Concomitant multiple myeloma spectrum diagnosis in a central retinal vein occlusion: a case report and review.

    Science.gov (United States)

    Borgman, Christopher J

    2016-07-01

    Multiple myeloma is a neoplastic plasma-cell disorder resulting from malignant plasma cells in the bone marrow. It can cause a hyperviscosity syndrome secondary to the paraproteinaemia associated with the disease. The increased hyperviscosity can lead to retinal vein occlusions and other ocular problems that may challenge clinicians. In patients with multiple myeloma and hypertension and/or diabetes mellitus, retinal changes appear similar and changes due to one disease or the other may be difficult to determine. A 48-year-old white female presented to the clinic with a complaint of blurry vision in her left eye. A full comprehensive ocular examination revealed a central retinal vein occlusion presumably from the patient's history of hypertension, diabetes mellitus and hypercholesterolaemia. Further bloodwork revealed monoclonal protein in the patient's serum and an increased percentage of plasma cells in the bone marrow. She was diagnosed with monoclonal gammopathy of undetermined significance, part of the multiple myeloma disease spectrum. She was referred to a retinal specialist for initiation of intravitreal injections of anti-vascular endothelial growth factor. Multiple myeloma has been implicated in younger patients as an underlying cause of retinal vein occlusions. Multiple myeloma should be considered as a differential diagnosis in young patients with retinal vein occlusions, even if other risk factors for venous occlusion like hypertension, diabetes mellitus and hypercholesterolaemia are present. Timely referral to the patient's primary care physician and haematologist is important for appropriate treatment and control of underlying systemic conditions. PMID:27079282

  7. Neochloris oleoabundans grown on anaerobically digested dairy manure for concomitant nutrient removal and biodiesel feedstock production

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Robert B. [University of Michigan, Department of Chemical Engineering, 2300 Hayward Drive, 3074 HH Dow, Ann Arbor, MI 48109 (United States); Costanza-Robinson, Molly S. [Middlebury College, Department of Chemistry and Biochemistry and Program for Environmental Studies, VT 05753 (United States); Spatafora, Grace A. [Middlebury College, Department of Biology, Middlebury, VT 05753 (United States)

    2011-01-15

    Microalgae have been investigated as a promising biodiesel feedstock; however, large-scale production is not currently cost-competitive with petroleum diesel, and its environmental impacts have received little attention. Using wastewater to supply nutrients for algal growth obviates synthetic fertilizer use, provides on-site nutrient removal, and reduces greenhouse gas emissions. In this work, anaerobically digested dairy manure was used to grow the oleaginous green alga Neochloris oleoabundans. In batch culture experiments with both synthetic media and anaerobic digester effluent, N. oleoabundans assimilated 90-95% of the initial nitrate and ammonium after 6 d and yielded 10-30% fatty acid methyl esters on a dry weight basis. Cellular lipid content and the N concentration in the growth media were inversely correlated. In addition, the proportion of polyunsaturated fatty acids (i.e. C16:3, C18:2, and C18:3) decreased with N concentration over time while the proportion of C18:1 fatty acid increased. Although N deficiency is likely the primary driver behind lipid accumulation, the influence of culture pH confounded results and requires further study. Other living microorganisms in the digester effluent were not observed to affect algal growth and lipid productivity, though the breakdown of organic nitrogen may have hindered lipid accumulation traditionally achieved through the manipulation of synthetic media. This work highlights the potential for waste-grown mono-algal cultures to produce high quality biodiesel while accomplishing simultaneous wastewater treatment. (author)

  8. Self-organized ECM-mimetic model based on an amphiphilic multiblock silk-elastin-like corecombinamer with a concomitant dual physical gelation process.

    Science.gov (United States)

    Fernández-Colino, Alicia; Arias, F Javier; Alonso, Matilde; Rodríguez-Cabello, J Carlos

    2014-10-13

    Although significant progress has been made in the area of injectable hydrogels for biomedical applications and model cell niches, further improvements are still needed, especially in terms of mechanical performance, stability, and biomimicry of the native fibrillar architecture found in the extracellular matrix (ECM). This work focuses on the design and production of a silk-elastin-based injectable multiblock corecombinamer that spontaneously forms a stable physical nanofibrillar hydrogel under physiological conditions. That differs from previously reported silk-elastin-like polymers on a major content and predominance of the elastin-like part, as well as a more complex structure and behavior of such a part of the molecule, which is aimed to obtain well-defined hydrogels. Rheological and DSC experiments showed that this system displays a coordinated and concomitant dual gelation mechanism. In a first stage, a rapid, thermally driven gelation of the corecombinamer solution takes place once the system reaches body temperature due to the thermal responsiveness of the elastin-like (EL) parts and the amphiphilic multiblock design of the corecombinamer. A bridged micellar structure is the dominant microscopic feature of this stage, as demonstrated by AFM and TEM. Completion of the initial stage triggers the second, which is comprised of a stabilization, reinforcement, and microstructuring of the gel. FTIR analysis shows that these events involve the formation of β-sheets around the silk motifs. The emergence of such β-sheet structures leads to the spontaneous self-organization of the gel into the final fibrous structure. Despite the absence of biological cues, here we set the basis of the minimal structure that is able to display such a set of physical properties and undergo microscopic transformation from a solution to a fibrous hydrogel. The results point to the potential of this system as a basis for the development of injectable fibrillar biomaterial platforms

  9. Concomitant administration of GonaCon™ and rabies vaccine in female dogs (Canis familiaris) in Mexico.

    Science.gov (United States)

    Vargas-Pino, Fernando; Gutiérrez-Cedillo, Verónica; Canales-Vargas, Erick J; Gress-Ortega, Luis R; Miller, Lowell A; Rupprecht, Charles E; Bender, Scott C; García-Reyna, Patricia; Ocampo-López, Juan; Slate, Dennis

    2013-09-13

    Mexico serves as a global model for advances in rabies prevention and control in dogs. The Mexican Ministry of Health (MMH) annual application of approximately 16 million doses of parenteral rabies vaccine has resulted in significant reductions in canine rabies during the past 20 years. One collateral parameter of rabies programs is dog population management. Enhanced public awareness is critical to reinforce responsible pet ownership. Surgical spaying and neutering remain important to prevent reproduction, but are impractical for achieving dog population management goals. GonaCon™, an anti-gonadotropin releasing hormone (GnRH) vaccine, was initially tested in captive female dogs on the Navajo Nation, 2008. The MMH led this international collaborative study on an improved formulation of GonaCon™ in captive dogs with local representatives in Hidalgo, Mexico in 2011. This study contained 20 bitches assigned to Group A (6 control), Group B (7 GonaCon™), and Group C (7 GonaCon™ and rabies vaccine). Vaccines were delivered IM. Animals were placed under observation and evaluated during the 61-day trial. Clinically, all dogs behaved normally. No limping or prostration was observed, in spite of minor muscle atrophy post-mortem in the left hind leg of dogs that received GonaCon™. Two dogs that began the study pregnant give birth to healthy pups. Dogs that received a GonaCon™ injection had macro and microscopic lesions consistent with prior findings, but the adverse injection effects were less frequent and lower in intensity. Both vaccines were immunogenic based on significant increases in rabies virus neutralizing antibodies and anti-GnRH antibodies in treatment Groups B and C. Simultaneous administration of GonaCon™ and rabies vaccine in Group C did not affect immunogenicity. Progesterone was suppressed significantly in comparison to controls. Future studies that monitor fertility through multiple breeding cycles represent a research need to determine the

  10. Phase I clinical trial of HER2-specific immunotherapy with concomitant HER2 kinase inhibtion

    Directory of Open Access Journals (Sweden)

    Hamilton Erika

    2012-02-01

    Full Text Available Abstract Background Patients with HER2-overexpressing metastatic breast cancer, despite initially benefiting from the monoclonal antibody trastuzumab and the EGFR/HER2 tyrosine kinase inhibitor lapatinib, will eventually have progressive disease. HER2-based vaccines induce polyclonal antibody responses against HER2 that demonstrate enhanced anti-tumor activity when combined with lapatinib in murine models. We wished to test the clinical safety, immunogenicity, and activity of a HER2-based cancer vaccine, when combined with lapatinib. Methods We immunized women (n = 12 with metastatic, trastuzumab-refractory, HER2-overexpressing breast cancer with dHER2, a recombinant protein consisting of extracellular domain (ECD and a portion of the intracellular domain (ICD of HER2 combined with the adjuvant AS15, containing MPL, QS21, CpG and liposome. Lapatinib (1250 mg/day was administered concurrently. Peripheral blood antibody and T cell responses were measured. Results This regimen was well tolerated, with no cardiotoxicity. Anti-HER2-specific antibody was induced in all patients whereas HER2-specific T cells were detected in one patient. Preliminary analyses of patient serum demonstrated downstream signaling inhibition in HER2 expressing tumor cells. The median time to progression was 55 days, with the majority of patients progressing prior to induction of peak anti-HER2 immune responses; however, 300-day overall survival was 92% (95% CI: 77-100%. Conclusions dHER2 combined with lapatinib was safe and immunogenic with promising long term survival in those with HER2-overexpressing breast cancers refractory to trastuzumab. Further studies to define the anticancer activity of the antibodies induced by HER2 vaccines along with lapatinib are underway. Trial registry ClinicalTrials.gov NCT00952692

  11. Early-Stage Breast Cancer Treated With 3-Week Accelerated Whole-Breast Radiation Therapy and Concomitant Boost

    Energy Technology Data Exchange (ETDEWEB)

    Chadha, Manjeet, E-mail: MChadha@chpnet.org [Department of Radiation Oncology, Beth Israel Medical Center, New York, New York (United States); Woode, Rudolph; Sillanpaa, Jussi [Department of Radiation Oncology, Beth Israel Medical Center, New York, New York (United States); Lucido, David [Department of Biostatistics, Beth Israel Medical Center, New York, New York (United States); Boolbol, Susan K.; Kirstein, Laurie; Osborne, Michael P.; Feldman, Sheldon [Division of Breast Surgery, Beth Israel Medical Center, New York, New York (United States); Harrison, Louis B. [Department of Radiation Oncology, Beth Israel Medical Center, New York, New York (United States)

    2013-05-01

    Purpose: To report early outcomes of accelerated whole-breast radiation therapy with concomitant boost. Methods and Materials: This is a prospective, institutional review board-approved study. Eligibility included stage TisN0, T1N0, and T2N0 breast cancer. Patients receiving adjuvant chemotherapy were ineligible. The whole breast received 40.5 Gy in 2.7-Gy fractions with a concomitant lumpectomy boost of 4.5 Gy in 0.3-Gy fractions. Total dose to the lumpectomy site was 45 Gy in 15 fractions over 19 days. Results: Between October 2004 and December 2010, 160 patients were treated; stage distribution was as follows: TisN0, n=63; T1N0, n=88; and T2N0, n=9. With a median follow-up of 3.5 years (range, 1.5-7.8 years) the 5-year overall survival and disease-free survival rates were 90% (95% confidence interval [CI] 0.84-0.94) and 97% (95% CI 0.93-0.99), respectively. Five-year local relapse-free survival was 99% (95% CI 0.96-0.99). Acute National Cancer Institute/Common Toxicity Criteria grade 1 and 2 skin toxicity was observed in 70% and 5%, respectively. Among the patients with ≥2-year follow-up no toxicity higher than grade 2 on the Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic scale was observed. Review of the radiation therapy dose–volume histogram noted that ≥95% of the prescribed dose encompassed the lumpectomy target volume in >95% of plans. The median dose received by the heart D{sub 05} was 215 cGy, and median lung V{sub 20} was 7.6%. Conclusions: The prescribed accelerated schedule of whole-breast radiation therapy with concomitant boost can be administered, achieving acceptable dose distribution. With follow-up to date, the results are encouraging and suggest minimal side effects and excellent local control.

  12. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population

    Directory of Open Access Journals (Sweden)

    Burfield AH

    2012-03-01

    Full Text Available Allison H Burfield1, Thomas TH Wan2, Mary Lou Sole3, James W Cooper41Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA; 2Health Services, Administration, and Medical Education, Director, Doctoral Progr