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Увеличенная длительность ответа на терапию ленватинибом у пациентов с раком щитовидной железы 甲状腺癌患者Lenvatinib治疗反应时间延长
Q4 Medicine Pub Date : 2018-11-07 DOI: 10.17650/2222-1468-2018-8-3-53-60
Andrew G. Gianoukakis, Corina E. Dutcus, N. Batty, Matthew Guo, Mahadi Ali Baig
We present an updated analysis of lenvatinib in radioiodine-refractory differentiated thyroid cancer (RR-DTC) with new duration of response (DOR) data unavailable for the primary analysis. In this randomized, double-blind, multicenter, placebo-controlled phase 3 study, patients ≥18 years old with measurable, pathologically confirmed RR-DTC with independent radiologic confirmation of disease progression within the previous 13 months were randomized 2:1 to oral lenvatinib 24 mg/day or placebo. The main outcome measures for this analysis are DOR and progression-free survival (PFS). The median DOR for all lenvatinib responders (patients with complete or partial responses; objective response rate: 60.2 %; 95 % confidence interval (CI) 54.2–66.1) was 30.0 months (95 % CI 18.4–36.7) and was generally similar across subgroups. DOR was shorter in patients with greater disease burden and with brain and liver metastases. Updated median PFS was longer in the overall lenvatinib group vs placebo (19.4 vs 3.7 months; hazard ratio (HR) 0.24; 99 % CI 0.17–0.35; nominal P <0.0001). In lenvatinib responders, median PFS was 33.1 months (95 % CI 27.8–44.6) vs 7.9 months (95 % CI 5.8–10.7) in nonresponders. The median DOR of 30.0 months seen with patients who achieved complete or partial responses with lenvatinib (60.2 %) demonstrates that lenvatinib responders can have prolonged, durable and clinically meaningful responses. Prolonged PFS (33.1 months) was also observed in these lenvatinib responders.
我们对乐伐替尼在放射性碘难治性分化型癌症(RR-DTC)中的最新分析进行了研究,新的反应持续时间(DOR)数据无法用于初步分析。在这项随机、双盲、多中心、安慰剂对照的3期研究中,年龄≥18岁、经病理学证实可测量的RR-DTC且在前13个月内经独立放射学证实疾病进展的患者以2:1的比例随机接受24 mg/天口服乐伐替尼或安慰剂。该分析的主要结果指标是DOR和无进展生存期(PFS)。所有乐伐替尼应答者(具有完全或部分应答的患者;客观应答率:60.2%;95%置信区间(CI)54.2–66.1)的DOR中位数为30.0个月(95%CI 18.4–36.7),各亚组之间总体相似。在疾病负担较大以及有脑和肝转移的患者中,DOR较短。总体乐伐替尼组的更新中位PFS比安慰剂组更长(19.4个月vs 3.7个月;危险比(HR)0.24;99%CI 0.17–0.35;标称P<0.0001)。在乐伐替尼应答者中,中位PFS为33.1个月(95%CI 27.8–44.6),而无应答者为7.9个月(95%CI 5.8–10.7)。乐伐替尼完全或部分缓解的患者的DOR中位数为30.0个月(60.2%),表明乐伐替尼有反应者可以具有长期、持久和临床意义的反应。在这些乐伐替尼应答者中也观察到PFS延长(33.1个月)。
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引用次数: 0
The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction 入住重症监护室对头颈部重建术后预后和并发症发生率的影响
Q4 Medicine Pub Date : 2018-11-07 DOI: 10.17650/2222-1468-2018-8-3-61-71
F. Carta, A. Figus, N. Chuchueva, Daniela Quartu, G. Sambiagio, R. Loche, C. Gerosa, R. Puxeddu
The study objective is to evaluate the utilisation and effectiveness of intensive care unit (ICU) in the postoperative period as to its potential benefits to the head and neck reconstruction services. Materials and methods . This is a retrospective study on 143 consecutive patients who underwent 144 major head and neck microvascular reconstructive procedures performed by a single surgeon, that focused on perioperative management and on the relation between admission to ICU and complications/outcomes. Results. Thirty-four (23.6 %) patients were admitted to ICU during the early postoperative period. Admission to ICU was not associated with lower incidence of complications compared to direct admission to the Head and Neck ward: 29.4 % vs 27.3 % (p = 0.807709). Conclusion. Routinely early postoperative admission to ICU seems not to improve outcomes and/or reduce complications, and, as a consequence, ICU admission should be restricted to selected patients only.
本研究的目的是评估重症监护病房(ICU)在术后期间的使用和有效性,以及其对头颈部重建服务的潜在益处。材料和方法。这是一项回顾性研究,对连续143例患者进行了144次头颈部微血管重建术,由一名外科医生进行,重点是围手术期管理和ICU入院与并发症/结果的关系。结果。34例(23.6%)患者在术后早期入住ICU。与直接入住头颈病房相比,入住ICU与更低的并发症发生率无关:29.4% vs 27.3% (p = 0.807709)。结论。常规的术后早期ICU住院似乎不能改善预后和/或减少并发症,因此,ICU住院应仅限于选定的患者。
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引用次数: 0
Glycifon ointment for basal cell carcinoma: treatment experience 甘草软膏治疗基底细胞癌的临床体会
Q4 Medicine Pub Date : 2016-06-22 DOI: 10.17650/2222-1468-2016-6-2-60-64
Рамил Суфиахметович Гараев, Л. Н. Залялютдинова, В. Р. Гильмутдинова, Р. Ш. Хасанов
It has been held studying of the remote results of treatment of 80 patients sick of a bazalioma by 30 % glyciphon ointment in the Republican Oncologic Dispensary of the Ministry of Health of Republic of Tatarstan. It is established that daily use of glyciphon ointment during the 20– 30 days cures patients with primary tumours, both single, and initially-plural I and II stages, in 98,3 % cases. The preparation is effective at recidivations of bazalioma arising after radiotherapy, surgical treatment, criotherapy. The using at recidivations after the combined treatment is inexpedient. Reduction of an exposition of ointment from 24 hours till 6 hours gives good clinical effect with absence of relapses of recidivations of tumors.
在鞑靼斯坦共和国卫生部共和国肿瘤诊所对80名bazalioma患者使用30% glyciphon软膏的远程治疗结果进行了研究。经证实,在20 - 30天内每天使用glyciphon软膏可治愈原发性肿瘤患者,包括单发和最初多发的I期和II期,在98.3%的病例中。该制剂对放射治疗、手术治疗、冷冻治疗后的巴扎瘤复发有效。联合治疗后再用是不合适的。将药膏暴露时间从24小时减少到6小时,临床效果良好,没有肿瘤复发。
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引用次数: 0
Reduced low-traumatic access thyroidectomy with central neck dissection 低创伤性甲状腺切除术合并中央颈部清扫术
Q4 Medicine Pub Date : 2016-03-30 DOI: 10.17650/2222-1468-2016-6-1-46-54
A. Shabunin, D. Dolidze, S. Podvyaznikov, K. Mel’nik, R. Mumladze, A. Vardanyan, I. N. Lebedinskiy, Z. A. Bagateliya, N. N. Gogitidze
Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC), the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 %) cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale) 68 (89.5 %) patient was recognized as a excellent, and 8 (10.5 %) as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results.
背景。2014年,俄罗斯约有1万名新诊断的甲状腺癌(TC)患者,其中大部分需要手术治疗。目前,对手术干预的质量有特殊的要求,主要取决于手术的根治性、并发症的最少性和良好的美容效果。材料和方法。本文报告2012-2015年在S.P. Botkin市临床医院接受手术治疗的76例分化型TC患者的治疗结果。所有患者均在全麻下行筋膜外手术,行甲状腺大体积切除术合并中央淋巴结清扫术。手术在颈部前方减少低创伤入路长度4-5厘米,不穿过肋前肌。为了预防喉瘫,使用放大装置和神经肌图对喉神经进行了可视化和识别。为了防止甲状旁腺功能减退症的发展,还进行了甲状旁腺的可视化和保存。为此,除其他措施外,采用光敏剂、蓝色光源和局部光谱的甲状旁腺可视化光动力学方法。结果。术后3例(3.9%)出现一过性甲状旁腺功能减退。在干预量表POSAS (Patient and observer scar assessment scale)上,68例(89.5%)评价为优,8例(10.5%)评价为良。结论。因此,采用建议的低创伤入路甲状腺切除术和中央性颈部清扫术使我们的手术干预更加完整,有可能避免永久性特定并发症的发生,并获得更好的功能和美学效果。
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引用次数: 1
Enlarged piloid astrocytoma of the midbrain: recurrence or pseudoprogression? A clinical case 中脑增大的乳突星形细胞瘤:复发还是假性进展?1例临床病例
Q4 Medicine Pub Date : 2016-03-30 DOI: 10.17650/2222-1468-2016-6-1-68-70
Ю. Ю. Трунин, А.В. Голанов, Василь Костюченко, М.В. Галкин, Е. А. Хухлаева, А. Н. Коновалов
Piloid astrocytoma (PA) is a glioma that is most frequently encountered in children (WHO grade I). According to most authors, stereotactic radiation (radiotherapy and radiosurgery) is an effective method to control tumor growth in patients with incomplete removal of PA and its recurrence. The authors describe a clinical case of a female patient with PA of the midbrain; during the first 7 months after radiation she showed an obvious enlargement of the tumor, as evidenced by magnetic resonance imaging (MRI), with its further regression without any antitumor treatment. A follow-up of the patient and a regular evaluation of her clinical status and MRI changes, as compared to the similar clinical cases and literature data, may suggest that PA enlargement early after radiotherapy is generally pseudoprogression rather than true progression of the tumor. An understanding of this phenomenon will be able to improve the assessment of radiotherapy results in patients with PA and to rule out unnecessary antitumor treatment in this category of patients.
毛样星形细胞瘤(Piloid astrocytoma, PA)是儿童中最常见的一种胶质瘤(WHO分级为I级),大多数作者认为立体定向放疗(放疗和放外科)是控制PA不完全切除患者肿瘤生长和复发的有效方法。作者描述了一个女性中脑PA患者的临床病例;在放疗后的前7个月,磁共振成像(MRI)显示肿瘤明显增大,未经任何抗肿瘤治疗,肿瘤进一步缩小。通过对患者的随访和定期评估其临床状况和MRI变化,与类似的临床病例和文献资料相比,可能提示放疗后早期PA增大通常是肿瘤的假进展,而不是真正的进展。了解这一现象将有助于改善对PA患者放疗效果的评估,并排除对这类患者进行不必要的抗肿瘤治疗。
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引用次数: 2
Эффективность применения лучевой терапии на фоне локальной гипертермии в лечении рака гортани и гортаноглотки 局部热疗治疗喉癌和喉癌的有效性
Q4 Medicine Pub Date : 2015-06-08 DOI: 10.17650/2222-1468-2015-5-2-8-13
Евгений Лхамацыренович Чойнзонов, Ирина Олеговна Спивакова, М. Р. Мухамедов, Ж. А. Старцева, Ольга Черемисина, И. Г. Фролова, Денис Кульбакин, П. В. Суркова
Cancer of the larynx and laryngopharynx, which is accessible to visual and instrumental examination, remains the most relevant and complicated problem among head and neck malignances as before. Investigations show that the incidence of cancer at these sites in Russia in the last decade has risen from 4.5 to 9.67 %. This is a severe and poor prognostic form of cancer, which is characterized by its nonspecific early clinical manifestations, complex anatomic and topographic structure, and a high rate of regional metastases. The mainstay of treatment for head and neck cancer involves 3 components: surgery, chemotherapy, and radiotherapy (RT), which are performed alone or in combination. The most commonly used technique is combined, frequently crippling due to organ-removing operations. The clinical introduction of current radio modifiers, local and deep hyperthermia systems, is a promising approach to improving the results of treatment, to enhancing the radiation damage of RT, and to achieving the tumor regression sufficient for surgical intervention without augmenting the early and late toxicity inherent in chemoradiation treatment. The results of the performed study of 35 patients with T2–3N0–2M0 laryngeal and laryngopharyngeal cancer proved the high efficiency of local hyperthermia in treating malignancies in this region during both preoperative (grades III– IV therapeutic pathomorphism) and radical beam RT.
喉癌和喉咽癌是头颈部恶性肿瘤中最相关和最复杂的问题,可以通过视觉和仪器检查。调查显示,在过去十年中,俄罗斯这些地区的癌症发病率从4.5%上升到9.67%。这是一种严重且预后不良的癌症,其特点是早期临床表现非特异性,解剖和地形结构复杂,区域转移率高。头颈癌的主要治疗包括3个组成部分:手术、化疗和放疗(RT),可单独或联合进行。最常用的技术是联合使用,经常由于器官切除手术而致残。临床引入当前的放射修饰剂,局部和深度热疗系统,是一种很有前途的方法,可以改善治疗结果,增强RT的辐射损伤,并实现足以进行手术干预的肿瘤消退,而不会增加放化疗固有的早期和晚期毒性。对35例T2-3N0-2M0型喉咽癌患者的研究结果表明,在术前(III - IV级治疗病理)和根治性放疗期间,局部热疗对该区域恶性肿瘤的治疗均有较高的疗效。
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引用次数: 1
Реконструктивно-пластические операции у пациентов со злокачественными новообразованиями языка, слизистой дна полости рта, виды пластики 恶性肿瘤患者的重建-整形手术,口腔粘膜,整形。
Q4 Medicine Pub Date : 2015-04-19 DOI: 10.17650/2222-1468-2015-1-15-18
З. А.-Г. Раджабова, Д. А. Ракитина, А. В. Гурин, Н. И. Коркола, Р. А. Нажмудинов, И. В. Дунаевский
The problem of restoring tissue defects after radical surgery for malignant tumors of the head and neck remains relevant, as there is no standardized approach for solving this problem. This article describes the various options for plastics of combined through defects of the floor of the mouth, of angle of the mouth, of the upper and lower lips, of lateral parts of the neck. The use of a particular type of arterialized flap depended on the depth and character of the existing tissue defect. The use of this methodology allowed to reach satisfactory cosmetic and functional results, as well as improve the quality of patient’s life.
头颈部肿瘤根治性手术后组织缺损置换的问题并没有失去其相关性。本文介绍了对口腔底、上下唇部分、嘴角、面颊、颈部外侧等穿孔性组合缺损进行整形和置换的效果,同时减少了手术器官的形态和功能。根据现有组织缺损的深度和性质,在游离和非游离版本的血管蒂上使用动脉化皮瓣应用各种塑料方法。患者在改善生活质量和适应社会方面取得了满意的美容和功能结果。
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引用次数: 1
МОНИТОРИНГ РАКА ГОРТАНИ В ПРОЦЕССЕ СПЕЦИАЛЬНОГО ЛЕЧЕНИЯ 在特殊治疗过程中监测喉癌
Q4 Medicine Pub Date : 2015-04-15 DOI: 10.17650/2222-1468-2012-0-1-42-45
И. Ю. Суровцев, В. Н. Королев, К. И. Кулаев, К. С. Зуйков, А. С. Аладин
The given paper attempts to objectify the course of a tumor process in patients diagnosed as having throat cancer during radiation or chemoradiation therapy. The authors propose a diagnostic algorithm which enables one not only to see the actual extent of a tumor, but also to estimate the degree of its resorption; hence, to more accurately plan special treatment and to timely change the treatment policy.
本文试图客观描述在放疗或放化疗期间诊断为咽喉癌的患者的肿瘤过程。作者提出了一种诊断算法,不仅可以看到肿瘤的实际范围,而且可以估计其吸收程度;因此,更准确地规划特殊治疗,及时改变治疗政策。
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引用次数: 0
ЛЕЧЕБНЫЙ ЭФФЕКТ СОЛАСОДИН-РАМНОЗИЛОВЫХ ГЛИКОЗИДОВ ПРИ КРУПНЫХ ЗЛОКАЧЕСТВЕННЫХ ОПУХОЛЯХ КОЖИ (ДВА КЛИНИЧЕСКИХ СЛУЧАЯ) 在严重恶性肿瘤(两个临床病例)中,solacdine - ramnosil糖苷的治疗效果
Q4 Medicine Pub Date : 2015-04-01 DOI: 10.17650/2222-1468-2012-0-2-88-91
Bill E. Cham
Solasodine rhamnosyl glycosides (BEC) are a new class of antineoplastics, the efficiency of which administered via intravenous, intraperitoneal, and intratumoral routes is higher than that of many other antitumor agents. Early investigations have established the efficiency of topical BEC applications as a treatment option for non-melanoma skin cancers. There have recently been two clinical cases that count in favor of the fact that the cream formulation Curaderm containing BEC has a very high efficacy in the treatment of large non-melanoma skin cancers that are incurable by other existing methods. Also, Curaderm treatment shows a splendid cosmetic effect.
Solasodine rhamnosyl glycosides (BEC)是一类新型的抗肿瘤药物,其通过静脉、腹腔和肿瘤内给药的效率高于许多其他抗肿瘤药物。早期的研究已经确立了局部应用BEC作为非黑色素瘤皮肤癌的治疗选择的有效性。最近有两个临床病例证明,含有BEC的乳膏配方Curaderm在治疗其他现有方法无法治愈的大型非黑色素瘤皮肤癌方面具有非常高的疗效。此外,Curaderm治疗显示出良好的美容效果。
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引用次数: 0
SURGICAL TACTICS REGARDING CEREBRAL METASTASES WITH HEMORRHAGES 脑转移性出血的手术策略
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.17650/2222-1468-2015-1-8-14
E. Prozorenko, V. Karakhan, A. Bekyashev, V. Alyoshin, D. M. Belov, D. Naskhletashvili, N. V. Sevyan, A. Mitrofanov
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引用次数: 0
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