BACKGROUND: Patients with carcinoma of the gallbladder have advanced, unresectable tumor at the time of presentation and face a dismal prognosis in the absence of a standard palliative chemotherapy regimen. This study...BACKGROUND: Patients with carcinoma of the gallbladder have advanced, unresectable tumor at the time of presentation and face a dismal prognosis in the absence of a standard palliative chemotherapy regimen. This study was undertaken to evaluate the efficacy and safety of combined chemotherapy of gemcitabine and carboplatin in 20 patients with advanced gallbladder carcinoma. METHODS: The criteria of eligibility included chemonaive patients with unresectable gallbladder cancer, bidimensionaIly measurable disease, Zubrod's performance status≤2, and adequate major organ function. The patients received gemcitabine (1000 mg/m^2) on days 1 and 8, and carboplatin (target AUC of 5.0 mg/ml) on day 1, in a 21-day cycle. CT was used for response assessment. RESULTS: In this group of 20 patients with advanced gallbladder carcinoma 6 were men and 14 women, with a median age of 55 years. The stage of the tumor at presentation was IVB in 14 patients (70%), IVA in 3 (15%) and Ⅲ in 3 (15%). Four patients (21%) achieved a complete response, and 3 (15.7%), a partial response; an overall response rate was 36.7%. The median time to progression of the tumor was 33.8 weeks, and 1-year survival rate of the patients was 43.3%. Anemia of WHO grade Ⅲ or Ⅳ was seen in 2 patients (10%) and 1 patient (5%), respectively. Grade Ⅲ neutropenia and thrombocytopenia were observed in 2 patients (10%) and 1 patient (5%), respectively. CONCLUSION: With mild toxicity, combined chemotherapy of gemcitabine and carhoplatin is effective in the treatment of advanced gallbladder carcinoma.展开更多
Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on t...Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.展开更多
Background: Bevacizumab is a recombinant humanized monoclonal antibody which targets Vasculoendothelial growth factor (VEGF)-A and prevents its binding to VEGF receptor 2 (VEGFR 2). It is approved in the first and sec...Background: Bevacizumab is a recombinant humanized monoclonal antibody which targets Vasculoendothelial growth factor (VEGF)-A and prevents its binding to VEGF receptor 2 (VEGFR 2). It is approved in the first and second line treatment of metastatic colorectal cancer along with combination chemotherapy. Hypertension is an on-target and a common side effect of the treatment with bevacizumab. The true incidence of bevacizumab induced hypertension and its grading remains unclear due to paucity of prospective studies in this regard. In our institution, majority of metastatic colorectal cancer patients receive bevacizumab along with cytotoxic chemotherapy. In Indian, a context prospective study on this topic is negligible;so we find it to be of high importance. Objectives: We have conducted a prospective observational study of all metastatic colorectal patients receiving bevacizumab with chemotherapy and satisfying the eligibility criteria. The objective of the study was to assess the incidence and the pattern of hypertension. Materials & Methods: Patients receiving bevacizumab with FOLFOX (5 Fluorouracil, Calcium Leucovorin & Oxaliplatin) or CapeOX (Capecitabine & Oxaliplatin) chemotherapy for metastatic colorectal cancer were enrolled in the study;blood pressure was monitored before bevacizumab administration and also for the next seven days. This was done for all the chemotherapy cycles. Results: 100% of patients developed hypertension of any grade and 20% received treatment as a part of newly detected hypertension. Majority of the patients had grade 1 hypertension. Other grade of hypertension was grade 2. The blood pressure peaked on 6<sup>th</sup> day of bevacizumab administration. Conclusions: Hypertension of any grade may develop in bevacizumab treated patients. The incidence is very high and it may reach even up to 100% if prospectively and meticulously evaluated for longer period of time.展开更多
Objective: To study the timing of Bevacizumab (BVC) in the overall treatment strategy of advanced metastatic colorectal cancer - early use (first-line) or later use. Methods: 41 patients with progressive metastatic co...Objective: To study the timing of Bevacizumab (BVC) in the overall treatment strategy of advanced metastatic colorectal cancer - early use (first-line) or later use. Methods: 41 patients with progressive metastatic colorectal carcinoma were included. Patients were randomized to receive chemotherapy with or without BVC. Primary end point was objective response. Secondary end points were median survival, time to tumor progression, and toxicity. Results: Partial response with second-line BVC group constituted 25% and 18.8% in patients with first-line chemotherapy and BVC-based regimen respectively, compared to 11.8% and 5.9% with second-line chemotherapy. Median time to progression was 3.1 vs. 2.3 months for cases with first-line chemotherapy and BVC-based regimens respectively. Median survival was 8.2 vs. 4 months in both groups respectively (P = 0.019). Conclusion: Second-line chemotherapy combined BVC had higher disease control rate (partial response and stable disease), median time to progression and median survival in BVC-na?ve patients compared to patients with first-line BVC-based therapy. BVC should be maintained in the second- and third-line settings, as cases with BVC discontinuation had significantly lower median time to disease progression and median survival. Selection of patients for use of BVC was recommended with taking into consideration the cost-benefit value and that the discontinuation of BVC would increase tumor progression.展开更多
文摘BACKGROUND: Patients with carcinoma of the gallbladder have advanced, unresectable tumor at the time of presentation and face a dismal prognosis in the absence of a standard palliative chemotherapy regimen. This study was undertaken to evaluate the efficacy and safety of combined chemotherapy of gemcitabine and carboplatin in 20 patients with advanced gallbladder carcinoma. METHODS: The criteria of eligibility included chemonaive patients with unresectable gallbladder cancer, bidimensionaIly measurable disease, Zubrod's performance status≤2, and adequate major organ function. The patients received gemcitabine (1000 mg/m^2) on days 1 and 8, and carboplatin (target AUC of 5.0 mg/ml) on day 1, in a 21-day cycle. CT was used for response assessment. RESULTS: In this group of 20 patients with advanced gallbladder carcinoma 6 were men and 14 women, with a median age of 55 years. The stage of the tumor at presentation was IVB in 14 patients (70%), IVA in 3 (15%) and Ⅲ in 3 (15%). Four patients (21%) achieved a complete response, and 3 (15.7%), a partial response; an overall response rate was 36.7%. The median time to progression of the tumor was 33.8 weeks, and 1-year survival rate of the patients was 43.3%. Anemia of WHO grade Ⅲ or Ⅳ was seen in 2 patients (10%) and 1 patient (5%), respectively. Grade Ⅲ neutropenia and thrombocytopenia were observed in 2 patients (10%) and 1 patient (5%), respectively. CONCLUSION: With mild toxicity, combined chemotherapy of gemcitabine and carhoplatin is effective in the treatment of advanced gallbladder carcinoma.
文摘Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.
文摘Background: Bevacizumab is a recombinant humanized monoclonal antibody which targets Vasculoendothelial growth factor (VEGF)-A and prevents its binding to VEGF receptor 2 (VEGFR 2). It is approved in the first and second line treatment of metastatic colorectal cancer along with combination chemotherapy. Hypertension is an on-target and a common side effect of the treatment with bevacizumab. The true incidence of bevacizumab induced hypertension and its grading remains unclear due to paucity of prospective studies in this regard. In our institution, majority of metastatic colorectal cancer patients receive bevacizumab along with cytotoxic chemotherapy. In Indian, a context prospective study on this topic is negligible;so we find it to be of high importance. Objectives: We have conducted a prospective observational study of all metastatic colorectal patients receiving bevacizumab with chemotherapy and satisfying the eligibility criteria. The objective of the study was to assess the incidence and the pattern of hypertension. Materials & Methods: Patients receiving bevacizumab with FOLFOX (5 Fluorouracil, Calcium Leucovorin & Oxaliplatin) or CapeOX (Capecitabine & Oxaliplatin) chemotherapy for metastatic colorectal cancer were enrolled in the study;blood pressure was monitored before bevacizumab administration and also for the next seven days. This was done for all the chemotherapy cycles. Results: 100% of patients developed hypertension of any grade and 20% received treatment as a part of newly detected hypertension. Majority of the patients had grade 1 hypertension. Other grade of hypertension was grade 2. The blood pressure peaked on 6<sup>th</sup> day of bevacizumab administration. Conclusions: Hypertension of any grade may develop in bevacizumab treated patients. The incidence is very high and it may reach even up to 100% if prospectively and meticulously evaluated for longer period of time.
文摘Objective: To study the timing of Bevacizumab (BVC) in the overall treatment strategy of advanced metastatic colorectal cancer - early use (first-line) or later use. Methods: 41 patients with progressive metastatic colorectal carcinoma were included. Patients were randomized to receive chemotherapy with or without BVC. Primary end point was objective response. Secondary end points were median survival, time to tumor progression, and toxicity. Results: Partial response with second-line BVC group constituted 25% and 18.8% in patients with first-line chemotherapy and BVC-based regimen respectively, compared to 11.8% and 5.9% with second-line chemotherapy. Median time to progression was 3.1 vs. 2.3 months for cases with first-line chemotherapy and BVC-based regimens respectively. Median survival was 8.2 vs. 4 months in both groups respectively (P = 0.019). Conclusion: Second-line chemotherapy combined BVC had higher disease control rate (partial response and stable disease), median time to progression and median survival in BVC-na?ve patients compared to patients with first-line BVC-based therapy. BVC should be maintained in the second- and third-line settings, as cases with BVC discontinuation had significantly lower median time to disease progression and median survival. Selection of patients for use of BVC was recommended with taking into consideration the cost-benefit value and that the discontinuation of BVC would increase tumor progression.
