Three percent diclofenac in 2.5% hyaluronan gel (DHA) is approved by the Food and Drug Administration (FDA) in the treatment of actinic keratoses (AK). We conducted a meta- analysis of the few prospective studies that...Three percent diclofenac in 2.5% hyaluronan gel (DHA) is approved by the Food and Drug Administration (FDA) in the treatment of actinic keratoses (AK). We conducted a meta- analysis of the few prospective studies that evaluated the effect of DHA on the target lesion number score TLNS0 (indicating complete resolution of all target lesions in the treatment area) and/or the cumulative target lesion number score CLNS0 (indicating resolution of the target and new lesions in the treatment area) with assessment 30 days after the end of treatment. A comprehensive search of the 1966- 2005 MEDLINE database and reviewof the reference lists of relevant articles identified the published randomised trials. Three studies were included, with a total of 364 patients. The placebowas the hyaluronan vehicule gel (HAV). The intention- to- treat analyses show that DHA significantly improve the TLNS0 (OR= 3.72; 95% CI=2.05- 6.74) and the CLNS0 (OR=4.09; 95% CI=2.55- 6.56) compare to HAV. Overall, 42/106 (39.6% CI: 30.8- 49.1% ) had a TLNS0 with mean treatment duration of 75 days ± 21 [mean± standard deviation (SD)], and 70/179 (39.1% CI: 32.3- 46.4% ) patients had a CLNS0 with a mean 78 days± 16 treatment duration. DHA is effective compared to HAV in the treatment of AK. Further studies should establish subgroup analyses according to sites and severity of the AK lesions in order to determine if more patients could be improved in restricted indications. Biopsies, a longer follow- up evaluation, and comparisons with the other treatments of AK will also be helpful in the future to define the place of this treatment in the management of AK.展开更多
Introduction: Early diagnosis and treatment of metastases have been shown to improve overall survival of melanoma patients. The purpose of this study was to evaluate the impact of extensive initial staging, including ...Introduction: Early diagnosis and treatment of metastases have been shown to improve overall survival of melanoma patients. The purpose of this study was to evaluate the impact of extensive initial staging, including positron emission tomography (PET) scan on the management of melanoma patients. Patients and methods: Forty-three patients with intermediate/poor prognosis primary melanoma benefited from complementary excision and sentinel lymph node biopsy (SLB) after clinical and paraclinical. staging (computed tomography, nuclear magnetic resonance and whole body fluorodeoxyglucose PET scan). Results: No systemic metastases were demonstrated, while the SLB procedure emphasized the presence of regional lymph node metastases in 10 patients as suggested by the PET scan in four patients (sensitivity of the PET scan 40% ). These 10 patients with early diagnosed lymph node involvement benefited from early surgery and were included in adju vant treatment protocols. A secondary primary cancer was fortuitously diagnosed and treated early in two patients. Conclusions: The development of new adjuvant therapies and therapeutic procedures (specific and non-specific immunotherapy, gamma-knife radiosurgery, etc.) now raises the relevance of extensive staging in intermediate/poor prognosis melanoma patients. We confirm in our series that PET scan is not useful to detect micrometastasis and cannot replace SLB in initial regional staging. However, we show in our study that 12 of 43 patients were treated early or were included early in treatment protocols thanks to the extensive staging procedure. Nevertheless, it seems important to evaluate through larger prospective trials the real impact of these early diagnoses and new treatments on overall survival before defining new diagnostic and therapeutic guidelines.展开更多
文摘Three percent diclofenac in 2.5% hyaluronan gel (DHA) is approved by the Food and Drug Administration (FDA) in the treatment of actinic keratoses (AK). We conducted a meta- analysis of the few prospective studies that evaluated the effect of DHA on the target lesion number score TLNS0 (indicating complete resolution of all target lesions in the treatment area) and/or the cumulative target lesion number score CLNS0 (indicating resolution of the target and new lesions in the treatment area) with assessment 30 days after the end of treatment. A comprehensive search of the 1966- 2005 MEDLINE database and reviewof the reference lists of relevant articles identified the published randomised trials. Three studies were included, with a total of 364 patients. The placebowas the hyaluronan vehicule gel (HAV). The intention- to- treat analyses show that DHA significantly improve the TLNS0 (OR= 3.72; 95% CI=2.05- 6.74) and the CLNS0 (OR=4.09; 95% CI=2.55- 6.56) compare to HAV. Overall, 42/106 (39.6% CI: 30.8- 49.1% ) had a TLNS0 with mean treatment duration of 75 days ± 21 [mean± standard deviation (SD)], and 70/179 (39.1% CI: 32.3- 46.4% ) patients had a CLNS0 with a mean 78 days± 16 treatment duration. DHA is effective compared to HAV in the treatment of AK. Further studies should establish subgroup analyses according to sites and severity of the AK lesions in order to determine if more patients could be improved in restricted indications. Biopsies, a longer follow- up evaluation, and comparisons with the other treatments of AK will also be helpful in the future to define the place of this treatment in the management of AK.
文摘Introduction: Early diagnosis and treatment of metastases have been shown to improve overall survival of melanoma patients. The purpose of this study was to evaluate the impact of extensive initial staging, including positron emission tomography (PET) scan on the management of melanoma patients. Patients and methods: Forty-three patients with intermediate/poor prognosis primary melanoma benefited from complementary excision and sentinel lymph node biopsy (SLB) after clinical and paraclinical. staging (computed tomography, nuclear magnetic resonance and whole body fluorodeoxyglucose PET scan). Results: No systemic metastases were demonstrated, while the SLB procedure emphasized the presence of regional lymph node metastases in 10 patients as suggested by the PET scan in four patients (sensitivity of the PET scan 40% ). These 10 patients with early diagnosed lymph node involvement benefited from early surgery and were included in adju vant treatment protocols. A secondary primary cancer was fortuitously diagnosed and treated early in two patients. Conclusions: The development of new adjuvant therapies and therapeutic procedures (specific and non-specific immunotherapy, gamma-knife radiosurgery, etc.) now raises the relevance of extensive staging in intermediate/poor prognosis melanoma patients. We confirm in our series that PET scan is not useful to detect micrometastasis and cannot replace SLB in initial regional staging. However, we show in our study that 12 of 43 patients were treated early or were included early in treatment protocols thanks to the extensive staging procedure. Nevertheless, it seems important to evaluate through larger prospective trials the real impact of these early diagnoses and new treatments on overall survival before defining new diagnostic and therapeutic guidelines.
