Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Background: Due to the limited number of clinical series and the lack of\nmulti-institutional or national registries concerning retroperitoneal sarcoma\n(RPS) extending to major arterio-venous structures, the short and long-term\nbenefits following concomitant resection of these major structures are still\nantagonistic. Objective: To present our institutional experience with RPS\ntumors, to assess their vascular involvement and to analyze the outcomes of\nonco-vascular approach. Patients and methods: A retrospective review of\nour institutional RPS patientsâ?? clinical charts was performed. All consecutive\nadult patients surgically treated for RPS were included. Resection of RPS tumors\nwas followed by histopathological examination for grading. Types of\nvascular involvement were assessed preoperatively. RPS tumors were resected\nen bloc together with blood vessels according to the type of vascular involvement\nand the surgical standards. Results: This study included 14 patients; 8\nmales (57%) and 6 females (43%) with RPS. Vascular resection was performed\nin all patients. Adherent structures were resected in 43%. Resection\nwas performed for 29% RPSs with arterial venous involvement, 14% with only\narterial involvement, and 57% with only venous involvement. All RPSs\nwere classified as high-grade lesions, and 64% showed secondarily major vessels\ninvolvement. 43% of patients were treated by arterial resection. 80% had\nvenous involvement. Venous resections were followed by venous reconstruction\nin all patients with both arterial and venous involvement. The morbidity\nrate was 43% while the mortality rate was 7%. Conclusion: Complete resection\nwith clear margins is important for long-term survival in patients with\nretroperitoneal soft tissue sarcomas....
Background: Diets that restrict energy or macronutrient intake (e.g. fasting/ketogenic diets (KDs)) may selectively\nprotect non-tumour cells during cancer treatment. Previous reviews have focused on a subset of dietary restrictions\n(DR) or have not performed systematic searches. We conducted a systematic scoping review of DR at the time of\ncancer treatment.\nMethods: MEDLINE, Embase, CINAHL, AMED and Web of Science databases were searched for studies of adults\nundergoing DR alongside treatment for cancer. Search results were screened against inclusion/exclusion criteria.\nData from included studies were extracted by two independent reviewers. Results were summarised narratively.\nResults: Twenty-three independent studies (34 articles), with small sample sizes, met the inclusion criteria. Four\ncategories were identified: KDs (10 studies), fasting (4 studies), protein restriction (5 studies) and combined\ninterventions (4 studies). Diets were tolerated well, however adherence was variable, particularly for KDs. Biomarker\nanalysis in KDs and fasting resulted in the expected increase in ketones or reduction in insulin-like growth factors,\nrespectively, however they did not reduce glucose.\nConclusions: Future research with adequately powered studies is required to test the effects of each DR\nintervention on treatment toxicities and outcomes. Further research into improving adherence to DR may improve\nthe feasibility of larger trials....
For high risk prostate cancer, the treatment volumes and even dose levels are\nstill a controversial issue. The aim of this study is to evaluate the dosemetric\nparameters and acute toxicity of dose-escalated whole pelvis (WP) Intensity\nModulated Radiation Therapy (IMRT) and volumetric modulated arc therapy\n(VMAT) prostate boost following neoadjuvant and concomitant with androgen\ndeprivation therapy in high-risk prostate cancer patients. This analysis included\n73 high-risk prostate cancer patients treated with WP-IMRT followed by boost\nto the prostate by VMAT to total dose of 80 Gy; between January 2014 and October\n2016. Androgen deprivation therapy (ADT) was given for all patients before\nand during radiation therapy. Drawing the dose volume histograms\n(DVHs) was done for planning target volumes (PTVs), including Prostate PTV\n& nodal PTV, and organs at risk including rectum, bladder, femoral heads, and\nbowel bag for the plans. Acute radiation toxicities were reported during the\nradiation course and the following 3 months. The DVH analysis showed good\ncoverage of PTVs and organs at risk doses were acceptable. No recorded acute\nGrade greater than equal to 3 toxicity. Acute grade 1 toxicity for Gastrointestinal (GI) and Genitourinary\n(GU) were 65% and 35% respectively, while Grade 2 toxicity was 30%\nfor both. The Proctitis and frequency were the commonest acute toxicity and\nwere maximal during the 5th week of radiation therapy. Dose escalation in two\nphases utilizing Simultaneous integrated boost (SIB) combined with ADT in\nhigh risk prostate cancer patient is feasible and associated with acceptable acute\nGI and GU toxicity....
Background: There is currently no evidence that hepatitis C virus (HCV) genotype affects survival in patients with\nhepatocellular carcinoma (HCC). This study aimed to investigate whether the HCV genotype affected the survival\nrate of patients with HCV-related HCC.\nMethods: We performed a retrospective cohort study using the data of patients with HCV-related HCC evaluated at\ntwo centers in Korea between January 2005 and December 2016. Propensity score matching between genotype 2\npatients and non-genotype 2 patients was performed to reduce bias.\nResults: A total of 180 patients were enrolled. Of these, 86, 78, and 16 had genotype 1, genotype 2, and genotype\n3 HCV-related HCC, respectively. The median age was 66.0 years, and the median overall survival was 28.6 months.\nIn the entire cohort, patients with genotype 2 had a longer median overall survival (31.7 months) than patients with\ngenotype 1 (28.7 months; P = 0.004) or genotype 3 (15.0 months; P = 0.003). In the propensity score-matched\ncohort, genotype 2 patients also showed a better survival rate than non-genotype 2 patients (P = 0.007). Genotype\n2 patients also had a longer median decompensation-free survival than non-genotype 2 patients (P = 0.001).\nHowever, there was no significant difference in recurrence-free survival between genotype 2 and non-genotype 2\npatients who underwent curative treatment (P = 0.077). In multivariate Cox regression analysis, non-genotype 2\n(hazard ratio, 2.19; 95% confidence interval, 1.29-3.71) remained an independent risk factor for death.\nConclusion: Among patients with HCV-related HCC, those with genotype 2 have better survival....
Background: The co-occurrence of type 1 autoimmune pancreatitis (AIP) and pancreatic tumor (PaT) has been\npreviously reported. Pure AIP cases have favorable prognosis and are primarily treated with steroids, while AIP cases\nwith PaT are associated with poor prognosis where the primary management is pancreatic resection. However, itâ??s a\nchallenge to timely identify the concurrent PaT in AIP because of their similar clinical and radiological manifestations.\nMethods: We retrospectively reviewed the data in two medical centers from January 2010 to April 2019. The inclusion\ncriteria were as follows: 1) completion of abdominal CT imaging before invasive procedures to the pancreas, 2) a final\ndiagnosis of type 1 AIP using the 2011 international consensus diagnostic criteria, 3) follow-up duration of at least one\nmonth unless AIP and PaT were identified simultaneously. The presence of PaT in AIP was made based on histopathological\nconfirmation, and the absence of PaT in AIP was defined as no pathological or radiological evidence of concurrent PaT.\nClinical and radiological characteristics including gender, age, surveillance period, serum IgG4 and Ca-199 levels, biopsy,\nextrapancreatic involvement, CT and MR (if performed) imaging characteristics were compared between AIP with and\nwithout PaT. The Fisherâ??s exact test was used for qualitative variables, and nonparametric Mann-Whitney test for quantitative\nvariables. A p value Less than equal to 0.05 was considered statistically significant.\nResults: A total of 74 patients with type 1 AIP were included, of which 5 (6.7%) had the concurrent PaT. The subtypes were\npancreatic ductal adenocarcinoma (3/5), solitary extramedullary plasmacytoma in the pancreas (1/5) and\ncholangiocarcinoma in the pancreatic segment (1/5), respectively. Gender (p = 0.044), the pattern of pancreatic enlargement\n(p = 0.003), heterogeneity (p = 0.015), low-density (p = 0.004) on CT and rim enhancement on MRI (p = 0.050) differed\nsignificantly between AIP with and without PaT. None of the low-density characteristics on CT or other assessed MRI\ncharacteristics could significantly differentiate the two groups (p>0.05).\nConclusions: Female, focal pancreatic enlargement, pancreatic heterogeneity, low-density on CT and rim enhancement on\nMRI are suggestive of the concurrent PaT in type 1 AIP. The characteristics of low-density on CT or other MRI characteristics\ndid not provide further diagnostic values....
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