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Pepe P.,Cannizzaro Hospital | Improta G.,Laboratory of Clinical Research and Molecular Diagnostics | Fraggetta F.,Cannizzaro Hospital | Emmanuele C.,Cannizzaro Hospital | And 4 more authors.
Anticancer Research | Year: 2014

Aim: The prostate-specific antigen (PSA) nadir and long-term outcome in patients with pT3b prostate cancer were evaluated. Patients and Methods: From July 2000 to December 2012, in 100 patients (median age=62 years) with pT3b prostate cancer following radical retropubic prostatectomy (RRP) preoperative and pathological findings predictive of PSA nadir (≤0.2 vs. >0.2 ng/ml) were retrospectively evaluated; moreover, biochemical recurrence-free survival (bRFS), cancer specific survival (CSS) and overall survival (OS) in patients who underwent watchful waiting (16 cases), adjuvant (84 cases) and salvage (10 cases) therapy were recorded. Results: A PSA nadir >0.2 ng/ml was correlated with node involvement, Gleason score ≥9, cT2, PSA >20 ng/ml, positive surgical margins and total cancer percentage >20%. At a median follow-up of 90 months (range=10-155 months) bRFS, OS and CSS were 92%, 96% and 80%, respectively. Conclusion: Radical retropubic prostatectomy combined with adjuvant and salvage treatments demonstrated a satisfactory outcome for pT3b prostate cancer. © 2014, International Institute of Anticancer Research. All rights reserved.

Curry R.C.,University of Cincinnati | Dahiya S.,Tufts University | Alva Venur V.,Cleveland Clinic | Raizer J.J.,Tumor Institute | Ahluwalia M.S.,Cleveland Clinic
Expert Review of Anticancer Therapy | Year: 2015

The survival of patients with high-grade gliomas (anaplastic gliomas and glioblastoma) remains poor despite current treatment modalities. However, an enhanced understanding of gliomagenesis is supporting the development of targeted molecular therapies with the potential for improving clinical outcomes. Glioblastoma (GBM) is characterized by extensive microvascular proliferation and the production of large amounts of VEGF. Bevacizumab is a humanized IgG1 monoclonal antibody that selectively binds with high affinity to human VEGF and neutralizes VEGF's biologic activity. Preclinical data indicate that angiogenesis is essential for the proliferation and survival of GBM cells. A number of studies have evaluated the outcomes of both newly diagnosed and recurrent GBM patients with bevacizumab in a prospective manner. Here, we discuss the role of bevacizumab in the treatment of anaplastic gliomas and GBM in the recurrent and upfront setting. © 2015 Informa UK Ltd.

Supportive care, or palliative care, in oncology patients has been a shifting paradigm in the last few years. Patients with advanced cancer experience significant symptom burden and psychosocial distress from the onset of their diagnosis and throughout treatment. The focus on cancer treatment often defers the integration of palliative care to a more "reactive" vs "proactive" approach, which can hinder symptom management. Many cancer centers are integrating palliative care programs in their practice; however, the scope of services and degree of intervention varies widely, especially with regard to the pharmacist's role. The purpose of this article is to describe the operational aspects of a multidisciplinary supportive oncology clinic at St. Luke's Mountain States Tumor Institute (MSTI). The MSTI supportive oncology clinic is a half-day clinic where complex patients are seen by a multidisciplinary team led by a nurse practitioner. The team also includes a nurse, a pharmacist, a dietitian, and a social worker. The pharmacist is responsible for medication reconciliation, which includes assessment for drug interactions, adverse effects, duplications in therapy, lack of efficacy, and untreated conditions. Within the first year of the supportive oncology clinic's operation, we saw a total of 75 patients. Use of a standardized pharmacy assessment helped to elucidate and address medication issues such as duplicate therapies (46.7% of patients), drug interactions (44%), side effects (74.7%), lack of efficacy (94.7%), and untreated conditions (73.3%). Pharmacists are uniquely trained in medication therapy management, and a thorough medication therapy review has been shown to assist other disciplines in their own assessments. © 2012 Elsevier Inc.

Zeng J.-Z.,Tumor Institute | Liu G.-Q.,Tumor Institute | Hao X.-B.,Tumor Institute | Hong T.,Tumor Institute | And 5 more authors.
Journal of Interventional Radiology (China) | Year: 2014

Objective: To investigate the changes of regulatory T cells (Treg) in patients with hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous cool-tip radiofrequency ablation (RFA), and to discuss its influence on the prognosis. Methods: A total of 30 patients with HCC were enrolled in this study. The percentage of Treg in peripheral blood was estimated with flow cytometry before RFA and one, 4, 7 and 12 months after RFA. During the follow-up period, the therapeutic effects were evaluated by contrast enhanced sonography or contrast enhanced CT scanning. By using the methods of receiver operating characteristic (ROC) curve and Kaplan-Meier survival function, the correlation of Treg dynamic changes with the progression-free survival time was analyzed. Results: One month after RTA, the tumor response (TR) rate in the 30 patients was 93.3% (28/30), the tumor progression (TP) rate was 6.67% (2/30). The percentage of Treg before RFA was (9.42 ± 1.16)%, which decreased to (6.55 ± 0.97)% one month after RFA, the difference was statistically significant (t = 15.325, P < 0.001). Twelve months after RFA, TR rate became 33.3% (10/30), and TP rate became 66.7%(20/30). The preoperative percentage of Treg of TR group was (8.75 ± 0.72)%, which was significantly lower than that of TP group (9.76 ± 1.20)%, the difference was statistically significant (t = -2.448, P = 0.021). ROC curves indicated that the optimal cut-off value of Treg nadir was 4.82%, the sensitivity was 90.0% and the specificity was 60.0%. The optimal cut-off time to reach Treg nadir was 5.5 months, the sensitivity was 70.0% and the specificity was 85.0%. Kaplan-Meier curve analysis showed that after RFA the progression-free survival rate (PFS) of patients with Treg nadir ≤ 4.82% was significantly higher than that of patients with Treg nadir > 4.82%. PFS of patients with reaching Treg nadir ≥ 5.5 months was significantly higher than that of patients with reaching Treg nadir < 5.5 months. Log-rank test results were χ2 = 5.207, P = 0.023; χ2= 22.079, P < 0.001, respectively. Conclusion: Percutaneous cool-tip radiofrequency ablation can decrease the percentage of Treg cells. Besides, Treg nadir and the time reaching Treg nadir can reflect the prognosis of HCC patients after RFA to a certain extent.

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