Atasoy A.,Diyarbakir Training and Research Hospital |
Bogdanovic G.,Oncology Institute of Vojvodina |
Cvijetic Z.,University of Sarajevo |
Dediu M.,Bucharest Institute of Oncology |
And 3 more authors.
Journal of B.U.ON. | Year: 2013
While pain is highly prevalent in cancer patients and its management is universally challenging, it is more commonly undertreated in the developing world. Southeastern European countries have limited resources and manpower to allocate for delivery of effective care for cancer-related pain. The purpose of this study was to explore the practice methods and the barriers to effective pain management in Southeastern Europe.Methods: We conducted a Web-based survey using a specially designed questionnaire among physicians practicing in member countries of the Balkan Union of Oncology (BUON). Results: A representative from each of the member countries of BUON (including Armenia and Georgia) and close to 100 physicians from 8 countries responded. The majority 89% of respondents were medical oncologists and had been practising for 10 years on average. For pain assessment, only 35.4% of the physicians used a formal pain scale. Of the respondents 34.1% were not able to reach the optimal doses of narcotic medications while managing cancer pain, mostly due to concerns about toxicity, such as constipation and nausea. Most physicians listed their inability to consuit sub-specialists to seek assistance for improving pain management cases as one of the major difficulties in dayto-day clinical practice, along with lack of time. Conclusions: The limitations faced by our respondents seem to be related mostly to the shortcomings of the respective health care systems, along with the need for more experience and knowledge about the titration of pain medications and dealing with toxicities.
Ianculescu V.,Gustave Roussy |
Ciolovan L.M.,Gustave Roussy |
Dunant A.,Gustave Roussy |
Vielh P.,Gustave Roussy |
And 6 more authors.
European Journal of Radiology | Year: 2014
Purpose To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Materials and methods Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. Results BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann-Whitney U test, p < 0.0001). By selecting a lesion cut-off value of 3.31 m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity. Conclusion VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies. © 2014 Elsevier Ireland Ltd.
Kerkhofs L.,Admiraal Of Ruyter Hospital |
Boschetti G.,Hopital Edouard Herriot |
Lugini A.,Ospedale San Camillo de Lellis |
Stanculeanu D.-L.,Bucharest Institute of Oncology |
Palomo A.G.,Hospital Of Leon
Future Oncology | Year: 2012
Aim: To evaluate the effectiveness of a biosimilar erythropoiesis- stimulating agent (Binocrit®) for the treatment of patients with cancer and chemotherapy-induced anemia in real-life clinical practice. Materials & methods: Data were collected retrospectively from patients at five European centers (in France, Italy, The Netherlands, Romania and Spain) who received treatment with Binocrit. Hemoglobin (Hb) levels were recorded at regular intervals during Binocrit therapy for up to 26 weeks. Hb response (an increase of ≥1 g/dl in 4 weeks or a Hb level in the range 10-12 g/dl during the study) was assessed in patients with a Hb level ≥8.5 g/dl at the start of therapy who received treatment for at least 6 weeks. Hb response rates in patients who did and did not receive intravenous (iv.) iron were also assessed, and data on any serious unexpected adverse events were collected. Results: Among evaluable patients (n = 113), 79% achieved a Hb response. Response rates were similar among evaluable patients who received an initial Binocrit dose of 30,000 or 40,000 IU/week (81 vs 78%; p = not significant). The Hb response rate was significantly greater in patients who received iv. iron than in patients who did not receive iv. iron (93 vs 77%; p < 0.05). No serious unexpected adverse events were reported. Conclusion: Use of the biosimilar erythropoiesis- stimulating agent Binocrit is effective and safe for the treatment of patients with cancer and chemotherapy-induced anemia. Supplementation with iv. iron increases the response rate compared with oral or no iron supplementation. © 2012 Future Medicine Ltd.
Vasilescu C.,Fundeni Institute of Digestive Disease and Liver Transplantation |
Tudor S.,Fundeni Institute of Digestive Disease and Liver Transplantation |
Popa M.,Fundeni Institute of Digestive Disease and Liver Transplantation |
Aldea B.,Bucharest Institute of Oncology |
Gluck G.,Institute of Nephrology
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2011
Objective: We present an entirely robotic total pelvic exenteration and extended lymphadenectomy with "barreled ureterocutaneostomy" and end colostomy for recurrent endometrial cancer. In 1948, Brunschwig first described a pelvic exenteration as treatment of advanced recurrent malignancy in the pelvis. Currently it represents the only potentially curative option for patients with recurrent endometrial cancer. Methods: A 69-year-old female with perineal recurrence invading urethral and vaginal walls, lower rectum and anal sphincter was the perfect candidate for total pelvic exenteration. Results: Total operative time was 250 minutes, with a console time of 175 minutes. The estimated blood loss was 365 mL. Conclusions: Good oncological results are expected after robotic total pelvic exenteration owing to the accurate, precise dissection and the extension of lymphadenectomy in the narrow space of the deep pelvis similar to robotic prostatectomy and total mesorectal excision. Copyright © 2011 by Lippincott Williams & Wilkins.